TRANEXAMIC ACID FOR THE PREVENTION AND THE TREATMENT OF PRIMARY POSTPARTUM HAEMORRHAGE: SYSTEMATIC REVIEW
Keywords:
Bleeding, Mortality rate, Postpartum haemorrhage, Tranexamic acidAbstract
Despite the fact that the majority of fatalities occur in the former two groups, postpartum hemorrhage remains a leading cause of maternal mortality in both high-income and low- and middle-income nations. Uterine atony, lacerations, retained placenta or clots, and a lack of clotting factors are the most prevalent causes of postpartum bleeding. The principal treatments for this disease are uterine massage, oxytocin, and methylergonovine, as well as blood transfusions and cardiovascular support. Tranexamic acid, sometimes known as TXA, is an antifibrinolytic medication that is commonly used in the treatment and prevention of bleeding. TXA is used to treat a wide range of disorders, including severe menstrual bleeding, trauma, postpartum hemorrhage, traumatic brain injury, and surgical site bleeding. Despite having been used for several decades and a large body of research, TXA is still viewed with suspicion in many therapeutic settings. The study found that the difference in postpartum hemorrhage, mortality, and adverse effects between those who got tranexamic acid and those who received a placebo was not statistically significant. Nonetheless, studies demonstrate that tranexamic acid can help reduce postpartum bleeding.
References
World Health Organization (WHO). Maternal mortality. Geneva; 2019.
Say L, Chou D, Gemmill A, Tunçalp Ö, Moller A-B, Daniels J, et al. Global causes of maternal death: a WHO systematic analysis. Lancet Glob Heal. Juni 2014;2(6):e323-33.
Ronsmans C, Graham WJ. Maternal mortality: who, when, where, and why. Lancet (London, England). September
;368(9542):1189–200.
Maswime S, Buchmann E. A systematic review of maternal near miss and mortality due to postpartum hemorrhage. Int J Gynecol Obstet. 2017;137(1):1–7.
Bienstock JL, Eke AC, Hueppchen NA. Postpartum Hemorrhage. N Engl J Med. April 2021;384(17):1635–45.
Kroh S, Waters JH. Obstetrical Hemorrhage. Anesthesiol Clin. Desember 2021;39(4):597–611.
Ducloy-Bouthors AS, Duhamel A, Kipnis E, Tournoys A, Prado-Dupont A, Elkalioubie A, et al. Postpartum haemorrhage related early increase in D-dimers is inhibited by tranexamic acid: haemostasis parameters of a randomized controlled open labelled trial. Br J Anaesth. Mei 2016;116(5):641–8.
Brenner A, Ker K, Shakur-Still H, Roberts I. Tranexamic acid for post-partum haemorrhage: What, who and when. Best Pract Res Clin Obstet Gynaecol. November 2019;61:66–74.
Relke N, Chornenki NLJ, Sholzberg M. Tranexamic acid evidence and controversies: An illustrated review. Res Pract Thromb Haemost. Juli 2021;5(5):e12546.
Bellos I, Pergialiotis V. Tranexamic acid for the prevention of postpartum hemorrhage in women undergoing cesarean delivery: an updated meta-analysis. Am J Obstet Gynecol. April 2022;226(4):510-523.e22.
Pacheco LD, Saade GR, Hankins GD V. Medical management of postpartum hemorrhage: An update. Semin Perinatol. Februari 2019;43(1):22–6.
Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with postpartum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial. Lancet (London, England). Mei 2017;389(10084):2105–16.
Shakur-Still H, Roberts I, Fawole B, Kuti M, Olayemi OO, Bello A, et al. Effect of tranexamic acid on coagulation and fibrinolysis in women with postpartum haemorrhage (WOMAN-ETAC): a single-centre, randomised, doubleblind, placebo-controlled trial. Wellcome open Res. 2018;3:100.
Sentilhes L, Sénat M V, Le Lous M, Winer N, Rozenberg P, Kayem G, et al. Tranexamic Acid for the Prevention of Blood Loss after Cesarean Delivery. N Engl J Med. April 2021;384(17):1623–34.
Sentilhes L, Winer N, Azria E, Sénat M-V, Le Ray C, Vardon D, et al. Tranexamic Acid for the Prevention of Blood Loss after Vaginal Delivery. N Engl J Med. Agustus 2018;379(8):731–42.
Li B, Miners A, Shakur H, Roberts I. Tranexamic acid for treatment of women with post-partum haemorrhage in Nigeria and Pakistan: a cost-effectiveness analysis of data from the WOMAN trial. Lancet Glob Heal. Februari 2018;6(2):e222–8.
Hertle E, Stehouwer CDA, van Greevenbroek MMJ. The complement system in human cardiometabolic disease. Mol Immunol. Oktober 2014;61(2):135–48.
Fauci AS, Jameson JL, Kasper D, et al. Harrison’s Principles of Internal Medicine 19th Edition. New York: McGrawHill Education; 2018.
Bruntol L, Dandan R, Knollmann B. Goodman & Gilman’s: The Pharmacological Basis of Therapeutics. Philadelphia: Mc Graw Hill Education; 2018.
Prieto-Merino D, Smeeth L, Staa TP van, Roberts I. Dangers of non-specific composite outcome measures in clinical trials. BMJ. November 2013;347:f6782.
Muhunthan K, Balakumar S, Navaratnaraja TS, Premakrishna S, Arulkumaran S. Plasma Concentrations of Tranexamic Acid in Postpartum Women After Oral Administration. Obstet Gynecol. April 2020;135(4):945–8.
Shah N, Hossain N, Shoaib R, Hussain A, Gillani R, Khan NH. Socio-demographic characteristics and the three delays of maternal mortality. J Coll Physicians Surg Pak. Februari 2009;19(2):95–8.
Oladapo OT, Adetoro OO, Ekele BA, Chama C, Etuk SJ, Aboyeji AP, et al. When getting there is not enough: a nationwide cross-sectional study of 998 maternal deaths and 1451 near-misses in public tertiary hospitals in a lowincome country. BJOG. Mei 2016;123(6):928–38.
Myles PS, Smith JA, Forbes A, Silbert B, Jayarajah M, Painter T, et al. Tranexamic Acid in Patients Undergoing Coronary-Artery Surgery. N Engl J Med. Januari 2017;376(2):136–48.
Dallaku K, Shakur H, Roberts I, Edwards P, Beaumont D, Delius M, et al. Effects of tranexamic acid on platelet function and thrombin generation (ETAPlaT): WOMAN trial sub-study. Wellcome open Res. Desember 2016;1:29.
Roberts I, Shakur H, Fawole B, Kuti M, Olayemi O, Bello A, et al. Haematological and fibrinolytic status of Nigerian women with post-partum haemorrhage. BMC Pregnancy Childbirth. Mei 2018;18(1):143.
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