Tranexamic Acid for the Prevention of Blood Loss After Vaginal Delivery

Sentilhes, Loïc; Winer, Norbert; Azria, Élie; Sénat, Marie-Victoire; Ray, Camille Le; Vardon, Delphine; Perrotin, F.; Desbrière, Raoul; Fuchs, Florent; Kayem, Gilles; Ducarme, Guillaume; Doret-Dion, Muriel; Huissoud, Cyril; Bohec, Caroline; Deruelle, Philippe; Darsonval, Astrid; Chrétien, Jean-Marie; Seco, Aurélien; Daniel, Valérie; Deneux-Tharaux, Catherine

doi:10.1097/ogx.0000000000000637

Cited by 14 publications

(27 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…11,12 TXA, alone or in conjunction with additional hemostatic therapies, enhances clot stability in whole blood from people with hemophilia. 13 TXA also reduces heavy menstrual bleeding, 14 perioperative blood loss following elective vaginal or cesarean delivery, [15][16][17] and death from postpartum hemorrhage. 18,19 However, TXA does not show survival benefit in patients with acute gastrointestinal bleeding 20 or in some studies of trauma.…”

Section: Introductionmentioning

confidence: 99%

Application of a plasmin generation assay to define pharmacodynamic effects of tranexamic acid in women undergoing cesarean delivery

Miszta

Ahmadzia

Luban

et al. 2021

Journal of Thrombosis and Haemostasis

View full text Add to dashboard Cite

Tranexamic acid (TXA) is an antifibrinolytic drug used to reduce bleeding. Assaying plasmin generation (PG) in plasma detects clinically relevant TXA levels in vitro and ex vivo. 3.1‐16.2 µg/mL TXA half‐maximally inhibits PG in plasma from women undergoing cesarean delivery. PG velocity shows the strongest dose‐relationship at low TXA concentrations (≤10 µg/mL). Abstract BackgroundTranexamic acid (TXA) is used to reduce bleeding. TXA inhibits plasmin(ogen) binding to fibrin and reduces fibrinolysis. TXA antifibrinolytic activity is typically measured by clot lysis assays; however, effects on plasmin generation (PG) are unclear due to a lack of tools to measure PG in plasma. AimsDevelop an assay to measure PG kinetics in human plasma. Determine effects of TXA on PG and compare with fibrinolysis measured by rotational thromboelastometry (ROTEM). MethodsWe characterized effects of plasminogen, tissue plasminogen activator, fibrinogen, and α2‐antiplasmin on PG in vitro. We also studied effects of TXA on PG in plasma from 30 pregnant women administered intravenous TXA (5, 10, or 15 mg/kg) during cesarean delivery. PG was measured by calibrated fluorescence. PG parameters were compared with TXA measured by mass spectrometry and ROTEM of whole blood. ResultsThe PG assay is specific for plasmin and sensitive to tissue plasminogen activator, fibrin(ogen), and α2‐antiplasmin. Addition of TXA to plasma in vitro dose dependently prolonged the clot lysis time and delayed and reduced PG. For all doses of TXA administered intravenously, the PG assay detected delayed time‐to‐peak (≤3 hours) and reduced the velocity, peak, and endogenous plasmin potential (≤24 hours) in plasma samples obtained after infusion. The PG time‐to‐peak, velocity, and peak correlated significantly with TXA concentration and showed less variability than the ROTEM lysis index at 30 minutes or maximum lysis. ConclusionsThe PG assay detects pharmacologically relevant concentrations of TXA administered in vitro and in vivo, and demonstrates TXA‐mediated inhibition of PG in women undergoing cesarean delivery.

show abstract

Section: Introductionmentioning

confidence: 99%

Application of a plasmin generation assay to define pharmacodynamic effects of tranexamic acid in women undergoing cesarean delivery

Miszta

Ahmadzia

Luban

et al. 2021

Journal of Thrombosis and Haemostasis

View full text Add to dashboard Cite

show abstract

“…The Tranexamic Acid for Preventing Postpartum Hemorrhage Following a Vaginal Delivery (TRAAP) trial enrolled 4079 laboring women who received tranexamic acid or placebo in addition to prophylactic oxytocin after delivery. PPH occurred in 8.5% of the tranexamic acid group vs 9.8% of the placebo group, and this difference was not statically significant (RR 0.83, 95% CI 0.68–1.01) 19 . However, a subsequent meta‐analysis of four clinical trials (N=4671) published by Saccone and colleagues found that women who received prophylactic tranexamic acid after vaginal delivery had a significantly lower risk of PPH (RR 0.61, 95% CI 0.41–0.91) 20 .…”

Section: Tranexamic Acid: Expanding Prevention and Treatment Options mentioning

confidence: 86%

Contemporary Issues in Women’s Health

Geary

Chibwesha

Stringer

2020

Intl J Gynecology & Obste

View full text Add to dashboard Cite

“…Although the use of tranexamic acid did not result in a significantly lower rate of blood loss of at least 500 ml than in the placebo group (relative risk [RR] 0.83; 95% CI 0.68–1.01; P = 0.07), it was nevertheless associated with lower rates of secondary outcomes such as provider‐assessed clinically significant postpartum haemorrhage (RR 0.74; 95% CI 0.61–0.91; P = 0.04 after adjustment for multiple comparisons). Altogether, these results suggested that routine administration of tranexamic acid in addition to an uterotonic may be cost‐effective 4 …”

Section: Introductionmentioning

confidence: 88%

An economic evaluation of tranexamic acid to prevent postpartum haemorrhage in women with vaginal delivery: the randomised controlled TRAAP trial

Durand-Zaleski

Deneux‐Tharaux

Seco

et al. 2020

BJOG

View full text Add to dashboard Cite

Objective To estimate the cost-effectiveness of tranexamic acid (TXA) use to prevent postpartum haemorrhage. Design A trial-based economic evaluation. Setting Fifteen French university maternity hospitals. Population Women enrolled in the TRAAP randomised controlled trial comparing TXA versus placebo in women with vaginal delivery. TRAAP failed to show a reduction in postpartum haemorrhage of at least 500 ml in the intervention arm but evidenced significant lower rates of secondary outcomes related to blood loss. Methods & main outcome measures We estimated direct medical costs from within-trial hospital resources collected prospectively from the study report form. All resources were costed at their value to the hospital. We estimated incremental cost per incremental haemorrhage averted. Results Among the 4079 women in the TRAAP trial, data necessary to calculate costs were available for 3836 (94.0%). The average total costs in the TXA and control groups were €2278 AE 388 and €2288 AE 409 per woman, respectively (P = 0.79). In women with postpartum haemorrhage of at least 500 ml (trial primary endpoint), costs were €2359 AE 354 and €2409 AE 525 (P = 0.14); for provider-assessed clinically significant postpartum haemorrhage and postpartum haemorrhage of at least 1000 ml, costs were respectively €2316 AE 347 versus €2381 AE 521 (P = 0.22) and €2321 AE 318 versus €2411 AE 590 (P = 0.35) in the tranexamic and placebo groups, respectively. The probabilistic sensitivity analysis showed that the use of TXA had a 65-73% probability of saving costs and improving outcome. Conclusions Our findings support the use of TXA, as both bleeding events and cost may be reduced three out of four times.

show abstract

Tranexamic Acid for the Prevention of Blood Loss After Vaginal Delivery

Cited by 14 publications

References 0 publications

Application of a plasmin generation assay to define pharmacodynamic effects of tranexamic acid in women undergoing cesarean delivery

Application of a plasmin generation assay to define pharmacodynamic effects of tranexamic acid in women undergoing cesarean delivery

Contemporary Issues in Women’s Health

An economic evaluation of tranexamic acid to prevent postpartum haemorrhage in women with vaginal delivery: the randomised controlled TRAAP trial

Contact Info

Product

Resources

About