Generic placeholder image

Current Women`s Health Reviews

Editor-in-Chief

ISSN (Print): 1573-4048
ISSN (Online): 1875-6581

Perspective

What is the Role of Tranexamic Acid in the Management of Postpartum Haemorrhage? State of Art and Perspectives

Author(s): Filippo Alberto Ferrari*, Simone Garzon Garz, Francesca Cisotto, Stefano Uccella and Massimo Franchi

Volume 19, Issue 4, 2023

Published on: 17 October, 2022

Article ID: e200522205092 Pages: 7

DOI: 10.2174/1573404818666220520152808

Price: $65

Abstract

Primary postpartum haemorrhage (PPH) complicates the postpartum up to 11% of deliveries with different incidences based on geographical regions and is the first cause of maternal deaths, accounting for 25% of cases. Tranexamic acid may play a role in the delicate postpartum balance in case of PPH, inhibiting the conversion of plasminogen to plasmin and reducing the degradation of fibrin. We analyze literature evidence and the possible role of tranexamic acid in clinical practice and future scenarios.

Keywords: Tranexamic acid, vaginal delivery, caesarean section, primary postpartum haemorrhage, obstetric care, uterine atony

[1]
Knight M, Callaghan WM, Berg C, et al. Trends in postpartum hemorrhage in high resource countries: A review and recommendations from the International Postpartum Hemorrhage Collaborative Group. BMC Pregnancy Childbirth 2009; 9(1): 55.
[http://dx.doi.org/10.1186/1471-2393-9-55] [PMID: 19943928]
[2]
Calvert C, Thomas SL,, Ronsmans C,, Wagner KS,, Adler AJ,, Filippi V,. Identifying regional variation in the prevalence of postpartum haemorrhage: a systematic review and meta-analysis. PLoS One 2012; 7(7): e41114.
[http://dx.doi.org/10.1371/journal.pone.0041114] [PMID: 22844432]
[3]
Ferrari F, Forte S, Prefumo F, Sartori E, Odicino F. Opportunistic salpingectomy during postpartum contraception procedures at elective and unscheduled cesarean delivery. Contraception 2019; 99(6): 373-6.
[http://dx.doi.org/10.1016/j.contraception.2019.03.041] [PMID: 30898658]
[4]
Mpemba F,, Kampo S,, Zhang X,. Towards 2015: post-partum haemorrhage in sub-Saharan Africa still on the rise. J Clin Nurs 2014; 23(5-6): 774-83.
[http://dx.doi.org/10.1111/jocn.12126] [PMID: 23472972]
[5]
Carroli G,, Cuesta C,, Abalos E,, Gulmezoglu AM. Epidemiology of postpartum haemorrhage: a systematic review. Best Pract Res Clin Obstet Gynaecol 2008; 22(6): 999-1012.
[http://dx.doi.org/10.1016/j.bpobgyn.2008.08.004] [PMID: 18819848]
[6]
Lutomski JE,, Byrne BM,, Devane D,, Greene RA,. Increasing trends in atonic postpartum haemorrhage in Ireland: an 11-year population-based cohort study. BJOG 2012; 119(3): 306-14.
[http://dx.doi.org/10.1111/j.1471-0528.2011.03198.x] [PMID: 22168794]
[7]
Kaelin Agten A,, Passweg D,, von Orelli S,, Ringel N,, Tschudi R,, Tutschek B,. Temporal trends of postpartum haemorrhage in Switzerland: a 22-year retrospective population-based cohort study. Swiss Med Wkly 2017; 147: w14551.
[http://dx.doi.org/10.4414/smw.2017.14551] [PMID: 29185249]
[8]
Blomberg M. Maternal obesity and risk of postpartum hemorrhage. Obstet Gynecol 2011; 118(3): 561-8.
[http://dx.doi.org/10.1097/AOG.0b013e31822a6c59] [PMID: 21860284]
[9]
Zito G, Corte LD, Giampaolino P, et al. Gestational diabetes mellitus: Prevention, diagnosis and treatment. A fresh look to a busy corner. J Neonatal Perinatal Med 2020; 13(4): 529-41.
[http://dx.doi.org/10.3233/NPM-190305] [PMID: 31903997]
[10]
Rizzo G, Garzon S, Fichera M, et al. Vitamin D and Gestational Diabetes Mellitus: Is There a Link? Antioxidants 2019; 8(11): 511.
[http://dx.doi.org/10.3390/antiox8110511] [PMID: 31731439]
[11]
Mehrabadi A,, Hutcheon JA,, Lee L,, Kramer MS,, Liston RM,, Joseph KS,. Epidemiological investigation of a temporal increase in atonic postpartum haemorrhage: a population-based retrospective cohort study. BJOG 2001; 120(7): 853-62.
[http://dx.doi.org/10.1111/1471-0528.12149] [PMID: 23464351]
[12]
Kramer MS,, Dahhou M,, Vallerand D,, Liston R,, Joseph KS,. Risk factors for postpartum hemorrhage: can we explain the recent temporal increase? J Obstet Gynaecol Can 2011; 33(8): 810-9.
[http://dx.doi.org/10.1016/S1701-2163(16)34984-2] [PMID: 21846436]
[13]
Ford JB, Patterson JA, Seeho SKM, Roberts CL. Trends and outcomes of postpartum haemorrhage, 2003-2011. BMC Pregnancy Childbirth 2015; 15(1): 334.
[http://dx.doi.org/10.1186/s12884-015-0788-5] [PMID: 26670767]
[14]
Rossen J, Økland I, Nilsen OB, Eggebø TM. Is there an increase of postpartum hemorrhage, and is severe hemorrhage associated with more frequent use of obstetric interventions? Acta Obstet Gynecol Scand 2010; 89(10): 1248-55.
[http://dx.doi.org/10.3109/00016349.2010.514324] [PMID: 20809871]
[15]
Hogan MC, Foreman KJ, Naghavi M, et al. Maternal mortality for 181 countries, 1980-2008: a systematic analysis of progress towards Millennium Development Goal 5. Lancet 2010; 375(9726): 1609-23.
[http://dx.doi.org/10.1016/S0140-6736(10)60518-1] [PMID: 20382417]
[16]
Harper A. Massive obstetric haemorrhage. Haemorrhage and thrombosis for the MRCOG and beyond. Royal Coll Obstetr Gynaecol 2014; 42-58.
[http://dx.doi.org/10.1017/CBO9781139924498.005]
[17]
Sebghati M, Chandraharan E. An update on the risk factors for and management of obstetric haemorrhage. Womens Health (Lond Engl) 2017; 13(2): 34-40.
[http://dx.doi.org/10.1177/1745505717716860] [PMID: 28681676]
[18]
Gülmezoglu AM, et al. Active management of the third stage of labour what is new and different about AMTSL in these recommendations. Lancet 2007; 379(9827): 1721-7.
[http://dx.doi.org/10.1016/S0140-6736(12)60206-2] [PMID: 22398174]
[19]
Vogel JP, Williams M, Gallos I, Althabe F, Oladapo OT. WHO recommendations on uterotonics for postpartum haemorrhage prevention: what works, and which one? BMJ Glob Health 2019; 4(2): e001466.
[http://dx.doi.org/10.1136/bmjgh-2019-001466] [PMID: 31139461]
[20]
Westhoff G, Cotter AM, Tolosa JE. Prophylactic oxytocin for the third stage of labour to prevent postpartum haemorrhage. Cochrane Libr 2013; 4(10): CD001808.
[http://dx.doi.org/10.1002/14651858.CD001808.pub2] [PMID: 24173606]
[21]
Vogel JP, Oladapo OT, Dowswell T, Gülmezoglu AM. Updated WHO recommendation on intravenous tranexamic acid for the treatment of post-partum haemorrhage. Lancet Glob Health 2018; 6(1): e18-9.
[http://dx.doi.org/10.1016/S2214-109X(17)30428-X] [PMID: 29100880]
[22]
Ducloy-Bouthors AS, Mignon A, Huissoud C, Grouin JM, Mercier FJ. Fibrinogen concentrate as a treatment for postpartum haemorrhage-induced coagulopathy: A study protocol for a randomised multicentre controlled trial. The fibrinogen in haemorrhage of delivery (FIDEL) trial. Anaesth Crit Care Pain Med 2016; 35(4): 293-8.
[http://dx.doi.org/10.1016/j.accpm.2015.10.011] [PMID: 27004917]
[23]
Hoylaerts M, Lijnen HR, Collen D. Studies on the mechanism of the antifibrinolytic action of tranexamic acid. Biochim Biophys Acta 1981; 673(1): 75-85.
[PMID: 7193484]
[24]
Åstedt B. Clinical pharmacology of tranexamic acid. Scand J Gastroenterol 1987; 22(sup137): 22-5.
[http://dx.doi.org/10.3109/00365528709089756] [PMID: 3321402]
[25]
Marietta M, Facchini L, Pedrazzi P, Busani S, Torelli G. Pathophysiology of bleeding in surgery. Transplant Proc 2006; 38(3): 812-4.
[http://dx.doi.org/10.1016/j.transproceed.2006.01.047] [PMID: 16647479]
[26]
Goldstein M, Feldmann C, Wulf H, Wiesmann T. Tranexamic acid prophylaxis in hip and knee joint replacement. Dtsch Arztebl Int 2017; 114(48): 824-30.
[http://dx.doi.org/10.3238/arztebl.2017.0824] [PMID: 29249226]
[27]
Giordano R, Palma G, Poli V, et al. Tranexamic acid therapy in pediatric cardiac surgery: a single-center study. Ann Thorac Surg 2012; 94(4): 1302-6.
[http://dx.doi.org/10.1016/j.athoracsur.2012.04.078] [PMID: 22819471]
[28]
Ker K, Edwards P, Perel P, Shakur H, Roberts I. Effect of tranexamic acid on surgical bleeding: systematic review and cumulative meta-analysis. BMJ 2012; 344(may17 1): e3054.
[http://dx.doi.org/10.1136/bmj.e3054] [PMID: 22611164]
[29]
Ker K, Prieto-Merino D, Roberts I. Systematic review, meta-analysis and meta-regression of the effect of tranexamic acid on surgical blood loss. Br J Surg 2013; 100(10): 1271-9.
[http://dx.doi.org/10.1002/bjs.9193] [PMID: 23839785]
[30]
Roberts I, Shakur H, Coats T, et al. The CRASH-2 trial: a randomised controlled trial and economic evaluation of the effects of tranexamic acid on death, vascular occlusive events and transfusion requirement in bleeding trauma patients. Health Technol Assess 2013; 17(10): 1-79.
[http://dx.doi.org/10.3310/hta17100] [PMID: 23477634]
[31]
Practice Bulletin No. 183 Summary: Postpartum Hemorrhage. Obstet Gynecol 2017; 130(4): 923-5.
[http://dx.doi.org/10.1097/AOG.0000000000002346] [PMID: 28937566]
[32]
Prevention and management of postpartum haemorrhage. BJOG 2017; 124(5): e106-49.
[http://dx.doi.org/10.1111/1471-0528.14178] [PMID: 27981719]
[33]
Ducloy-Bouthors AS, Jude B, Duhamel A, et al. High-dose tranexamic acid reduces blood loss in postpartum haemorrhage. Crit Care 2011; 15(2): R117.
[http://dx.doi.org/10.1186/cc10143] [PMID: 21496253]
[34]
Shakur H, Roberts I, Fawole B, et al. Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial. Lancet 2017; 389(10084): 2105-16.
[http://dx.doi.org/10.1016/S0140-6736(17)30638-4] [PMID: 28456509]
[35]
Bouthors AS, Hennart B, Jeanpierre E, et al. Therapeutic and pharmaco-biological, dose-ranging multicentre trial to determine the optimal dose of TRAnexamic acid to reduce blood loss in haemorrhagic CESarean delivery (TRACES): study protocol for a randomised, double-blind, placebo-controlled trial. Trials 2018; 19(1): 148.
[http://dx.doi.org/10.1186/s13063-017-2420-7] [PMID: 29490682]
[36]
Ker K, Roberts I, Chaudhri R, et al. Tranexamic acid for the prevention of postpartum bleeding in women with anaemia: study protocol for an international, randomised, double-blind, placebo-controlled trial. Trials 2018; 19(1): 712.
[http://dx.doi.org/10.1186/s13063-018-3081-x] [PMID: 30594227]
[37]
Yang H, Zheng S, Shi C. Clinical study on the efficacy of tranexamic acid in reducing postpartum blood lose: a randomized, comparative, multicenter trial. Zhonghua Fu Chan Ke Za Zhi 2001; 36(10): 590-2.
[PMID: 16134519]
[38]
Asıcıoğlu O, Yıldırım G, Ark C, Tekirdağ A, Besımoglu B, Gungorduk K. Can intravenous injection of tranexamic acid be used in routine practice with active management of the third stage of labor in vaginal delivery? A randomized controlled study. Am J Perinatol 2012; 30(5): 407-14.
[http://dx.doi.org/10.1055/s-0032-1326986] [PMID: 23023559]
[39]
Sentilhes L, Winer N, Azria E, et al. Tranexamic Acid for the Prevention of Blood Loss after Vaginal Delivery. N Engl J Med 2018; 379(8): 731-42.
[http://dx.doi.org/10.1056/NEJMoa1800942] [PMID: 30134136]
[40]
Alam A, Choi S. Prophylactic use of tranexamic acid for postpartum bleeding qutcomes: A systematic review and meta-analysis of randomized controlled trials. Transfus Med Rev 2015; 29(4): 231-41.
[http://dx.doi.org/10.1016/j.tmrv.2015.07.002] [PMID: 26282735]
[41]
Li C, Gong Y, Dong L, Xie B, Dai Z. Is prophylactic tranexamic acid administration effective and safe for postpartum hemorrhage prevention? Medicine (Baltimore) 2017; 96(1): e5653.
[http://dx.doi.org/10.1097/MD.0000000000005653] [PMID: 28072700]
[42]
Novikova N, Hofmeyr GJ, Cluver C. Tranexamic acid for preventing postpartum haemorrhage. Cochrane Libr 2015; 6(6): CD007872.
[http://dx.doi.org/10.1002/14651858.CD007872.pub3] [PMID: 26079202]
[43]
Pacheco LD, Hankins GDV, Saad AF, Costantine MM, Chiossi G, Saade GR. Tranexamic acid for the management of obstetric hemorrhage. Obstet Gynecol 2017; 130(4): 765-9.
[http://dx.doi.org/10.1097/AOG.0000000000002253] [PMID: 28885402]
[44]
Gai M, Wu L, Su Q, Tatsumoto K. Clinical observation of blood loss reduced by tranexamic acid during and after caesarian section: a multi-center, randomized trial. Eur J Obstet Gynecol Reprod Biol 2004; 112(2): 154-7.
[http://dx.doi.org/10.1016/S0301-2115(03)00287-2] [PMID: 14746950]
[45]
Sekhavat L, Tabatabaii A, Dalili M, Farajkhoda T, Tafti AD. Efficacy of tranexamic acid in reducing blood loss after cesarean section. J Matern Fetal Neonatal Med 2009; 22(1): 72-5.
[http://dx.doi.org/10.1080/14767050802353580] [PMID: 19165682]
[46]
Gungorduk K, Yıldırım G, Asıcıoğlu O, Gungorduk O, Sudolmus S, Ark C. Efficacy of intravenous tranexamic acid in reducing blood loss after elective cesarean section: A prospective, randomized, double-blind, placebo-controlled study. Am J Perinatol 2011; 28(3): 233-40.
[http://dx.doi.org/10.1055/s-0030-1268238] [PMID: 20979013]
[47]
Movafegh A, Eslamian L, Dorabadi A. Effect of intravenous tranexamic acid administration on blood loss during and after cesarean delivery. Int J Gynaecol Obstet 2011; 115(3): 224-6.
[http://dx.doi.org/10.1016/j.ijgo.2011.07.015] [PMID: 21872857]
[48]
O.; G. Tarabrin S. Tkachenko, R. Gulyaev, A. Shcherbakov, S. Gavrychenko, D., Reduced blood loss during Caesarean section under the action of tranexamic acid: 6AP2-11. Eur J Anaesthesiol 2012; 29: 97.
[http://dx.doi.org/10.1097/00003643-201206001-00316]
[49]
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(4): 427-31.
[http://dx.doi.org/10.4103/1658-354X.121077] [PMID: 24348295]
[50]
Abdel-Aleem H, Alhusaini TK, Abdel-Aleem MA, Menoufy M, Gülmezoglu AM. Effectiveness of tranexamic acid on blood loss in patients undergoing elective cesarean section: randomized clinical trial. J Matern Fetal Neonatal Med 2013; 26(17): 1705-9.
[http://dx.doi.org/10.3109/14767058.2013.794210] [PMID: 23574458]
[51]
Sentürk MB, Cakmak Y, Yildiz G, Yildiz P. Tranexamic acid for cesarean section: a double-blind, placebo-controlled, randomized clinical trial. Arch Gynecol Obstet 2013; 287(4): 641-5.
[http://dx.doi.org/10.1007/s00404-012-2624-8] [PMID: 23143410]
[52]
Shahid A, Khan A. Tranexamic acid in decreasing blood loss during and after caesarean section. J Coll Physicians Surg Pak 2013; 23(7): 459-62.
[PMID: 23823946]
[53]
Xu J, Gao W, Ju Y. Tranexamic acid for the prevention of postpartum hemorrhage after cesarean section: a double-blind randomization trial. Arch Gynecol Obstet 2013; 287(3): 463-8.
[http://dx.doi.org/10.1007/s00404-012-2593-y] [PMID: 23064441]
[54]
Anuradha Ghosha Bikas Muhuri PC. Efficacy of intravenous tranexamic acid before cesarean section in preventing post partum hemorrhage- a prospective randomised double blind placebo controlled study, 2014
[55]
Ramani B, Nayak L. Intravenous 1 gram tranexamic acid for prevention of blood loss and blood transfusion during caesarean section: A randomized case control study. Int J Reprod Contracept Obstet Gynecol 2014; 3: 366.
[56]
Singh T, Burute SB, Deshpande HG, Jethani S, Ratwani K. Efficacy of tranexamic acid in decreasing blood loss during and after caesarean section: A randomized case control prospective study. J Evol Med Dent Sci 2014; 3(11): 2780-8.
[http://dx.doi.org/10.14260/jemds/2014/2209]
[57]
Yehia AH, Koleib MH, Abdelazim IA, Atik A. Tranexamic acid reduces blood loss during and after cesarean section: A double blinded, randomized, controlled trial. Asian Pac J Reprod 2014; 3(1): 53-6.
[http://dx.doi.org/10.1016/S2305-0500(14)60002-6]
[58]
Nergis Taj Nadeem Akhtar AF. Muhammad Hamid Chaudhary, Sarah, Zunaira Bajwa, Ehsan Ullah, Efficacy of tranexamic acid in reducing blood loss during and after cesarean section. Rawal Med J 2014; 39(3): 311-3.
[59]
Maged AM, Helal OM, Elsherbini MM, et al. A randomized placebo-controlled trial of preoperative tranexamic acid among women undergoing elective cesarean delivery. Int J Gynaecol Obstet 2015; 131(3): 265-8.
[http://dx.doi.org/10.1016/j.ijgo.2015.05.027] [PMID: 26341174]
[60]
Lakshmi SJD, Abraham R. Role of prophylactic tranexamic acid in reducing blood loss during elective caesarean section: A randomized controlled study. J Clin Diagn Res 2016; 10(12): QC17-21.
[http://dx.doi.org/10.7860/JCDR/2016/21702.9050] [PMID: 28208943]
[61]
Ray I, Bhattacharya R, Chakraborty S, Bagchi C, Mukhopadhyay S. Role of intravenous tranexamic acid on caesarean blood loss: A prospective randomised study. J Obstet Gynaecol India 2016; 66(S1) (Suppl. 1): 347-52.
[http://dx.doi.org/10.1007/s13224-016-0915-x] [PMID: 27651628]
[62]
Sujata N, Tobin R, Kaur R, Aneja A, Khanna M, Hanjoora VM. Randomized controlled trial of tranexamic acid among parturients at increased risk for postpartum hemorrhage undergoing cesarean delivery. Int J Gynaecol Obstet 2016; 133(3): 312-5.
[http://dx.doi.org/10.1016/j.ijgo.2015.09.032] [PMID: 26952346]
[63]
Naeiji Z, Delshadiyan N, Saleh S, Moridi A, Rahmati N, Fathi M. Prophylactic use of tranexamic acid for decreasing the blood loss in elective cesarean section: A placebo-controlled randomized clinical trial. J Gynecol Obstet Hum Reprod 2021; 50(1): 101973.
[http://dx.doi.org/10.1016/j.jogoh.2020.101973] [PMID: 33221559]
[64]
Sentilhes L, Sénat MV, Le Lous M, et al. Tranexamic acid for the prevention of blood loss after cesarean delivery. N Engl J Med 2021; 384(17): 1623-34.
[http://dx.doi.org/10.1056/NEJMoa2028788] [PMID: 33913639]

Rights & Permissions Print Cite
© 2024 Bentham Science Publishers | Privacy Policy