Renal Cortical Necrosis in Postpartum Hemorrhage: A Case Series

Risk of Tranexamic Acid for Treatment of Postpartum Hemorrhage

“…As described by the authors, all women received tranexamic acid (TXA), and duration of TXA administration was the only factor associated with a poor kidney outcome at 6 months. 1 Although we acknowledge the balanced conclusions of the authors, we believe that this new piece of evidence questions the relevance of some guidelines in which the use of TXA for postpartum hemorrhage treatment now appears to have been overenthusiastically encouraged, with no clear recommendations for maximal dose and duration 2 and despite the lack of robust evidence. The rationale for these recommendations is based on: (1) an extrapolation from randomized controlled trials conducted in other clinical contexts 3 and (2) results of EXADELI, an openlabel randomized controlled trial in women with postpartum hemorrhage 4 but with methodological limitations.…”

Antifibrinolytic therapy for preventing VWD-related postpartum hemorrhage: indications and limitations

“…This seemed to correlate with the duration of TA exposure. 25 Unfortunately, this was a case finding study without a denominator of the total number of patients reported in that region who received TA over that 4-year period. Another French study of 68 postpartum women admitted to the intensive care unit with postpartum renal failure showed by univariate regression analysis an association with TA use (P 5 .03), but this did not hold upon multivariate regression analysis.…”

“…24 Renal failure was not observed in these studies, but a recent retrospective study of renal cortical necrosis was observed in 18 patients from 5 nephrology units in France over a 4-year period. 25 All patients had severe PPH and had received TA at a loading dose of 1 to 4 g, and 16/18 received a maintenance dose over 2 to 16 hours. Importantly, all 18 patients necessitated hemodialysis, and 6 months postpartum 8/18 (44%) have remained dialysis dependent.…”

The expanding role of tranexamic acid in the management of obstetric hemorrhage

“…First, there have been reported serious thromboembolic events related to its administration that warrant attention. A case cluster of 18 parturients developed renal cortical thrombosis in France following tranexamic acid administration that involved continuous infusion (17). For context, this is a complication that is extremely rare in pregnancy, and all of these previously young healthy women suffered permanent kidney damage with eight requiring dialysis six months postpartum.…”