Tranexamic Acid and Ethamsylate for Reducing Blood Loss in Patient Undergoing Lower Segment Cesarean Section at High Risk for Post-Partum Hemorrhage: A Pilot Study

Al-Anwar, Ahmed; Akl, Sherif; El-Mekawi, Sherif; Gamal, Marwan M.

doi:10.4236/ojog.2020.1090123

Cited by 8 publications

(11 citation statements)

References 21 publications

(19 reference statements)

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“…The current study revealed that there is No significant difference between the studied groups regarding age, BMI, parity, gestational age, and indications of cesarean section. Which was supported by study of (Alanwar & Gamal, 2020) 14 as they reported that there was no significant difference as regard patient characteristics (age, weight, BMI, and gestational age) between study and control groups.…”

Section: Discussionmentioning

confidence: 63%

“…According to (Alanwar & Gamal, 2020) 14 they demonstrated that intraoperative intravenous administration of tranexamic acid together with ethamsylate given just after delivery of the fetus is an effective method for reduction of blood loss during elective lower-segment cesarean delivery. Furthermore, tranexamic acid and ethamsylate reduce the need for ecbolic drugs during the postoperative period and reduces the postpartum blood loss in patients with high risk for postpartum hemorrhage.…”

Section: Discussionmentioning

confidence: 99%

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Comparative Study Between Oxytocin Versus Tranexamic Acid And Ethamsylate To Reduce Blood Loss Intra-operative And Postoperative During Elective Cesarean Section

Mohamed¹,

Farhan²,

Alsheikh

2021

Al-Azhar International Medical Journal

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Background: Delivery bleeding is still a major catastrophe that facing most of obstetricians, leading to global maternal exhaustion and fatality. So estimation of the blood loss and the changes occurring during the procedure are important in the management of the bleeding. Aim of the study: : Comparing loss of blood during Cesarean Delivery, Intra and post-operative in parturients, injected by Oxytocin versus Tranexamic acid with Ethamsylate. Patients and Methods: Blinded randomized controlled trial, whereas 200 of Gravid women shared and equally distributed to double collections, each collection includes 100 of women and Each of them is injected with Syntocinon 5 IU infusion on 500 cc saline 0.9%, at rate of 100cm/hour Or Tranexamic acid with Ethamsylate, 5 to 10 min IV slowly before the abdominal delivery, with evaluation of the bleeding amount.Results: Blood loss amount, participants requiring for blood transfer OR more intervention, were minimal in the tranexamic acid and ethamsylate collection than in the oxytocin collection. Moreover the results of hemoglobin and hematocrit postoperatively were elevated in the participants who injected by both tranexamic acid and ethamsylate comparing with the participants who injected by the Syntocinon. Conclusion:The Evaluated variables with the positive and negative results of the research medications, demonstrated the following: Both Tranexamic acid and Ethamsylate could be effective than Oxytocin in minimizing the demand for blood transfer, with the stability of both hematologic profile and the hemodynamics. And both too, appear to be safe and efficient option in the management of the abdominal delivery.

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Section: Discussionmentioning

confidence: 63%

Section: Discussionmentioning

confidence: 99%

Comparative Study Between Oxytocin Versus Tranexamic Acid And Ethamsylate To Reduce Blood Loss Intra-operative And Postoperative During Elective Cesarean Section

Mohamed¹,

Farhan²,

Alsheikh

2021

Al-Azhar International Medical Journal

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“…Uterotonic drugs are used as prophylactic measures to decrease the bleeding amount whether intra-operative or post-operative such as ergometrine, prostaglandin E1, prostaglandin F2α, carbetocin, and oxytocin [ 11 ]. Other drugs can be used to activate the hemostasis process such as tranexamic acid and ethamsylate [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

Comparative study between oxytocin and combination of tranexamic acid and ethamsylate in reducing intra-operative bleeding during emergency and elective cesarean section after 38 weeks of normal pregnancy

Bosilah,

Eldesouky,

Alghazaly

et al. 2023

BMC Pregnancy Childbirth

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Objective Cesarean Section (CS) is associated with an increased risk of hemorrhage. Many drugs are used to decrease this risk. We aim to compare the combination of ethamsylate and tranexamic acid, oxytocin, and placebo in women undergoing CS. Methods We conducted a double-blinded, randomized, placebo-controlled trial between October and December 2020 in four university hospitals in Egypt. The study included all pregnant women in labor without any complications who accepted to participate in the study between October and December 2020. The participants were divided into three groups. The subjects were randomly allocated to receive either oxytocin (30 IU in 500 ml normal saline during cesarean section), combined one gram of tranexamic acid with 250 mg of ethamsylate once before skin incision, or distilled water. Our main outcome was the amount of blood loss during the operation. The secondary outcomes were the need for blood transfusion, hemoglobin and hematocrit changes, hospital stay, operative complications, and the need for a hysterectomy. The one-way ANCOVA test was used to compare the quantitative variables between the three groups while the Chi-square test was used to compare the qualitative variables. Post hoc analysis then was performed to compare the difference between every two groups regarding the quantitative variables. Results Our study included 300 patients who were divided equally into three groups. Tranexamic acid with ethamsylate showed the least intra-operative blood loss (605.34 ± 158.8 ml) compared to oxytocin (625.26 ± 144.06) and placebo (669.73 ± 170.69), P = 0.015. In post hoc analysis, only tranexamic acid with ethamsylate was effective in decreasing the blood loss compared to placebo (P = 0.013); however, oxytocin did not reduce blood loss compared to saline (P = 0.211) nor to tranexamic acid with ethamsylate (P = 1). Other outcomes and CS complications showed no significant difference between the three groups except for post-operative thrombosis which was significantly higher in the tranexamic and ethamsylate group, P < 0.00001 and the need for a hysterectomy which was significantly increased in the placebo group, P = 0.017. Conclusion The combination of tranexamic acid and ethamsylate was significantly associated with the least amount of blood loss. However, in pairwise comparisons, only tranexamic acid with ethamsylate was significantly better than saline but not with oxytocin. Both oxytocin and tranexamic acid with ethamsylate were equally effective in reducing intra-operative blood loss and the risk of hysterectomy; however, tranexamic acid with ethamsylate increased the risk of thrombotic events. Further research with a larger number of participants is needed. Trial registration The study was registered on Pan African Clinical Trials Registry with the following number: PACTR202009736186159 and was approved on 04/09/2020.

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“…It has been clinically established that intravenous TXA reduces surgical blood loss and mortality due to bleeding without any obvious safety issues in surgical patients and as well reduces the need for blood transfusion 16,17 . However, much work has not been done in evaluating the haemostatic effect of intravenous ETH in major gynaecological surgeries 18 .…”

Section: Discussionmentioning

confidence: 99%

“…They noted that TXA and ETH improved health-related quality of life in women with menorrhagia by reducing blood loss, with TXA demonstrating superior haemostatic effect over ETH. There is dearth of literature on haemostatic effect of ETH on gynaecological surgeries; Alanwar et al 18 reported in 2020, that no previous clinical trial has investigated the role of ETH in either prophylaxis or treatment of hemorrhage during surgery, that their study was the first to do so. However, they evaluated the combination of TXA and ETH in Cesarean delivery, and noted that the study drugs significantly reduced intraoperative and postoperative blood loss.…”

Section: Discussionmentioning

confidence: 99%

A Randomized Comparative Trial of the Haemostatic Effect of Tranexamic Acid and Ethamsylate in Major Gynaecological Surgeries

Nnaji

Mmegwa

2022

Int J Health Sci Res

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Objective: Major gynaecological surgeries like abdominal myomectomy and hysterectomy are often associated with bleeding, this could affect patient’s outcome during anaesthesia, by either increasing the perioperative morbidity and or mortality. The aim of our study is to compare the haemostatic effect of tranexamic acid and ethamsylate in patients undergoing epidural anaesthesia for major abdominal gynaecological surgeries. Methods: Ethical clearance for this prospective randomized double-blind controlled study was obtained from the Ethics and Research Committee of a tertiary health institution in Nigeria (FMC/OW/HREC/245). Written informed consent was obtained from each of the patients scheduled for abdominal myomectomy or hysterectomy on elective basis, before being enrolled into this study. We recruited 90 patients and randomize them to either Group A (n=30) to received intravenous Tranexamic acid 15mg/kg, Group B (n=30) to receive intravenous Ethamsylate 12.5mg/kg or Group C (n=30) to receive Placebo (normal saline), 30 minutes before the induction of epidural anaesthesia. All data were entered into a data collection form and analysed with the statistical package for social sciences (SPSS) 21. Parametric data was analysed using two-tailed analysis of variance (ANOVA) for independent groups. A p-value of <0.05 was considered significant. Results: A total of 90 patients were recruited into this study and they all completed the research. The duration of surgery was significantly longer in Group A (162.67±52.49 min), compared with Group B (151.87±55.31 min) and Group C (126.57±45.67 min), p=0.024. The comparison of the preoperative and postoperative Hb in Group A shows a decrease of 10.10%, and the difference was statistically significant, p=0.001. But when the preoperative and postoperative Hb were compared in Group B and Group C, the decrease in Hb significantly increased in Groups B (13.29%; p<0.0001) and Group C (14%; p<0.0001). Conclusion: The administration of intravenous tranexamic acid before the induction of epidural anaesthesia for abdominal myomectomy or hysterectomy reduced the intraoperative and postoperative blood loss more, compared to the administration of intravenous ethamsylate or placebo, however with no clinical significance or apparent side effect. Key words: Tranexamic acid, ethamsylate, haemostasis, surgical blood loss .

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Tranexamic Acid and Ethamsylate for Reducing Blood Loss in Patient Undergoing Lower Segment Cesarean Section at High Risk for Post-Partum Hemorrhage: A Pilot Study

Cited by 8 publications

References 21 publications

Comparative Study Between Oxytocin Versus Tranexamic Acid And Ethamsylate To Reduce Blood Loss Intra-operative And Postoperative During Elective Cesarean Section

Comparative Study Between Oxytocin Versus Tranexamic Acid And Ethamsylate To Reduce Blood Loss Intra-operative And Postoperative During Elective Cesarean Section

Comparative study between oxytocin and combination of tranexamic acid and ethamsylate in reducing intra-operative bleeding during emergency and elective cesarean section after 38 weeks of normal pregnancy

A Randomized Comparative Trial of the Haemostatic Effect of Tranexamic Acid and Ethamsylate in Major Gynaecological Surgeries

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