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EDITORIAL
Year : 2013  |  Volume : 7  |  Issue : 4  |  Page : 365-366

Tranexamic acid in obstetrics: Encouraging data in anemic parturients


Jeanne de Flandre Academic Hospital, Avenue Oscar Lambret 59037, Lille, France

Correspondence Address:
Anne-Sophie Ducloy-Bouthors
Jeanne de Flandre Academic Hospital, Avenue Oscar Lambret 59037, Lille
France
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1658-354X.121040

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Date of Web Publication7-Nov-2013
 


How to cite this article:
Ducloy-Bouthors AS. Tranexamic acid in obstetrics: Encouraging data in anemic parturients. Saudi J Anaesth 2013;7:365-6

How to cite this URL:
Ducloy-Bouthors AS. Tranexamic acid in obstetrics: Encouraging data in anemic parturients. Saudi J Anaesth [serial online] 2013 [cited 2021 Sep 23];7:365-6. Available from: https://www.saudija.org/text.asp?2013/7/4/365/121040

In this issue of Saudi Journal of Anesthesia, Goswami et al. described the bleeding reduction and blood sparing of two doses of tranexamic acid (TA) used prophylactically before elective caesarean section (CS) in anemic patients. [1]

Because coagulopathy and hyperfibrinolysis is often associated with tissue injury and a clear predictor of bad outcome, antifibrinolytic drugs may be of interest in the management of massive bleeding. TA is a synthetic analog of lysine that blocks the interaction between native fibrin and activated plasminogen; thus, inhibiting the dissolution of the clot. TA has been used for long as an efficient drug to reduce the blood loss and spare blood products in the perioperative period or in menorrhagia. [2] Beneficial effects of the preventive use of TA have been established in large randomized blinded trials in major cardiac or orthopedic surgery. Henry et al. analyzed the published trials and established the demonstration of the transfusion need reduction. [3] Shakur et al. demonstrated a reduction of overall mortality and massive bleeding related mortality in trauma patients receiving an early dose of 1 g TA without any adverse effects. [4]

Post-partum hemorrhage remains the leading cause of maternal mortality and morbidity, especially by severe post-partum anemia. [5] In ongoing post-partum hemorrhage , a high dose of 4 g TA reduces the blood loss, duration of bleeding, and transfusion need in a randomized controlled trial. [6] Ferrer et al. provided a meta-analysis of all randomized trials published in elective CS. [7] The coherence of the trials was high: A preventive use of various doses of TA before CS reduced slightly, but significantly the bleeding volume and hemorrhagic CS rate. [7] In this forthcoming issue of the journal, the randomized double-blind placebo controlled trial compared two doses regimens of 10 mg/kg or 15 mg/kg TA administered prophylactically in anemic parturients undergoing CS. The choice of this sensible population increased the clinical pertinence of the study because of the blood loss reduction, even limited to 100 mL, avoided packed red blood cell transfusion in the two TA groups compared to the placebo group. The 15 mg/kg dose showed a greater benefit on bleeding and post-partum hemoglobin level than the 10 mg/kg dose. The World Maternal Antifibrinolytic Trial (WOMAN) trial, large international randomized placebo controlled, is yet running to compare the impact of a 1 g dose of TA at the onset of post-partum bleeding on mortality. [8] In obstetrics, TA use was generally well-tolerated: The major adverse effects described were rare and the minor adverse effects were moderate (nausea and visual disturbances). TA has the clear advantage of being an inexpensive, stable, off-the shelf, and easy-to-use drug. Because severe post-partum anemia remains a woman health challenge and blood products availability is sometimes limited, the use of TA should be considered in selected anemic population.

 
  References Top

1.Goswami U, Sarangi S, Gupta S, Babbar S. Comparative evaluation of two doses of tranexamic acid used prophylactically in anemic parturients for lower segment cesarean section: A double-blind randomized case control prospective trial. Saudi J Anaesth 2013;7:427-31.  Back to cited text no. 1
  Medknow Journal  
2.McCormack PL. Tranexamic acid: A review of its use in the treatment of hyperfibrinolysis. Drugs 2012;72:585-617.  Back to cited text no. 2
    
3.Henry DA, Carless PA, Moxey AJ, O'Connell D, Stokes BJ, McClelland B, et al. Anti-fibrinolytic use for minimising perioperative allogeneic blood transfusion. Cochrane Database Syst Rev. 2007;17:CD001886.  Back to cited text no. 3
    
4.CRASH-2 trial collaborators, Shakur H, Roberts I, Bautista R, Caballero J, Coats T, et al. Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): A randomised, placebo-controlled trial. Lancet 2010;376:23-32.  Back to cited text no. 4
    
5.Hogan MC, Foreman KJ, Naghavi M, Ahn SY, Wang M, Makela SM, et al. Maternal mortality for 181 countries, 1980-2008: A systematic analysis of progress towards Millennium Development Goal 5. Lancet 2010;375:1609-23.  Back to cited text no. 5
    
6.Ducloy-Bouthors AS, Jude B, Duhamel A, Broisin F, Huissoud C, Keita-Meyer H, et al. High-dose tranexamic acid reduces blood loss in postpartum haemorrhage. Crit Care 2011;15:R117.  Back to cited text no. 6
    
7.Ferrer P, Roberts I, Sydenham E, Blackhall K, Shakur H. Anti-fibrinolytic agents in post partum haemorrhage: A systematic review. BMC Pregnancy Childbirth 2009;9:29.  Back to cited text no. 7
    
8.Shakur H, Elbourne D, Gülmezoglu M, Alfirevic Z, Ronsmans C, Allen E, et al. The WOMAN Trial (World Maternal Antifibrinolytic Trial): Tranexamic acid for the treatment of postpartum haemorrhage: An international randomised, double blind placebo controlled trial. Trials 2010;11:40.  Back to cited text no. 8
    




 

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