Tranexamic acid and obstetric hemorrhage: give empirically or selectively?

Shander, Aryeh; Javidroozi, Mazyar; Sentilhes, Loïc

doi:10.1016/j.ijoa.2021.103206

Cited by 21 publications

(11 citation statements)

References 85 publications

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“…Antifibrinolytic therapy, used prophylactically for vaginal 913,914 or caesarean delivery 915,916 might reduce blood loss and the need for additional treatment, but the clinical impact and relevance needs to be established together with the identification of relevant high-risk groups 917 . TXA might be given before or after cord clamping or delivery, but neonatal aspects are not clarified yet 918 . Oral and intramuscular administration of TXA is being investigated as an alternative route 919 …”

Section: Discussionmentioning

confidence: 99%

“…917 TXA might be given before or after cord clamping or delivery, but neonatal aspects are not clarified yet. 918 Oral and intramuscular administration of TXA is being investigated as an alternative route. 919 Treatment with TXA as treatment or prophylaxis in parturients is not associated with increased risk of thrombosis.…”

Section: Viscoelastic Haemostatic Assaysmentioning

confidence: 99%

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Management of severe peri-operative bleeding: Guidelines from the European Society of Anaesthesiology and Intensive Care

Kietaibl

Ahmed

Afshari

et al. 2023

European Journal of Anaesthesiology

101

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BACKGROUND Management of peri-operative bleeding is complex and involves multiple assessment tools and strategies to ensure optimal patient care with the goal of reducing morbidity and mortality. These updated guidelines from the European Society of Anaesthesiology and Intensive Care (ESAIC) aim to provide an evidence-based set of recommendations for healthcare professionals to help ensure improved clinical management. DESIGN A systematic literature search from 2015 to 2021 of several electronic databases was performed without language restrictions. Grading of Recommendations, Assessment, Development and Evaluation (GRADE) was used to assess the methodological quality of the included studies and to formulate recommendations. A Delphi methodology was used to prepare a clinical practice guideline. RESULTS These searches identified 137 999 articles. All articles were assessed, and the existing 2017 guidelines were revised to incorporate new evidence. Sixteen recommendations derived from the systematic literature search, and four clinical guidances retained from previous ESAIC guidelines were formulated. Using the Delphi process on 253 sentences of guidance, strong consensus (>90% agreement) was achieved in 97% and consensus (75 to 90% agreement) in 3%. DISCUSSION Peri-operative bleeding management encompasses the patient's journey from the pre-operative state through the postoperative period. Along this journey, many features of the patient's pre-operative coagulation status, underlying comorbidities, general health and the procedures that they are undergoing need to be taken into account. Due to the many important aspects in peri-operative nontrauma bleeding management, guidance as to how best approach and treat each individual patient are key. Understanding which therapeutic approaches are most valuable at each timepoint can only enhance patient care, ensuring the best outcomes by reducing blood loss and, therefore, overall morbidity and mortality. CONCLUSION All healthcare professionals involved in the management of patients at risk for surgical bleeding should be aware of the current therapeutic options and approaches that are available to them. These guidelines aim to provide specific guidance for bleeding management in a variety of clinical situations.

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Section: Discussionmentioning

confidence: 99%

Section: Viscoelastic Haemostatic Assaysmentioning

confidence: 99%

Management of severe peri-operative bleeding: Guidelines from the European Society of Anaesthesiology and Intensive Care

Kietaibl

Ahmed

Afshari

et al. 2023

European Journal of Anaesthesiology

101

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“…Since the publication of the WOMAN trial, there has been uncertainty about the applicability of the study findings to patients in high-income countries [29][30][31][32]. Moreover, in a narrative review of deaths in the WOMAN trial, Picetti et al [33] found no deaths occurred in the European trial sites, with death occurring more often in those who delivered out of hospital (mortality rate, 6.2 vs. 1.9%; RR ¼ 3.12; 95% CI, 2.55-3.81; P < 0.001), and allogeneic blood often unavailable due to a shortage or relatives being unable to purchase it.…”

Section: Postpartum Hemorrhage Treatmentmentioning

confidence: 99%

Evaluating tranexamic acid for the prevention and treatment of obstetric hemorrhage

Kowalczyk,

Cecconi,

Butwick

2023

Current Opinion in Obstetrics &Amp; Gynecology

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Purpose of review Tranexamic acid (TXA) has emerged as a promising pharmacological adjunct to treat and prevent postpartum hemorrhage (PPH). We provide an overview of TXA, including its pharmacology, key findings of randomized trials and observational studies, and critical patient safety information. Recent findings Pharmacokinetic data indicate that TXA infusions result in peak plasma concentration within 3 min (range: 1–6.6 min). Ex-vivo pharmacodynamic data suggest that low-dose TXA (5 mg/kg) inhibits maximum lysis for at least 1 h. In predominantly developing countries, TXA has demonstrated a 19% reduction in the risk of bleeding-related death among patients with PPH. Based on high-quality randomized trials, TXA prophylaxis does not effectively reduce the risk of PPH during vaginal delivery and is likely ineffective in reducing the PPH risk during cesarean delivery. TXA exposure does not increase the risk of maternal thrombotic events. Maternal deaths have occurred from accidental intrathecal TXA injection from look-alike medication errors. Summary TXA has shown promise as an important adjunct for PPH treatment, especially in low-resource settings. However, TXA is not recommended as PPH prophylaxis during vaginal or cesarean delivery. Patient safety initiatives should be prioritized to prevent maternal death from accidental intrathecal TXA injection.

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“…Experts recommend that providers consider TXA as a therapeutic adjunct for treating PPH after vaginal or cesarean delivery and that future studies examine goal-directed treatment protocols using functional coagulation assays. 24,81,82 Clinicians based in developing countries or hospitals with limited access to blood products and other resources may have a lower threshold for using TXA than those based in well-resourced and well-staffed hospitals.…”

Section: Anesthesia and Analgesiamentioning

confidence: 99%

Update on Applications and Limitations of Perioperative Tranexamic Acid

Patel

Wyrobek

Butwick

et al. 2022

Anesthesia &Amp; Analgesia

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Tranexamic acid (TXA) is a potent antifibrinolytic with documented efficacy in reducing blood loss and allogeneic red blood cell transfusion in several clinical settings. With a growing emphasis on patient blood management, TXA has become an integral aspect of perioperative blood conservation strategies. While clinical applications of TXA in the perioperative period are expanding, routine use in select clinical scenarios should be supported by evidence for efficacy. Furthermore, questions regarding optimal dosing without increased risk of adverse events such as thrombosis or seizures should be answered. Therefore, ongoing investigations into TXA utilization in cardiac surgery, obstetrics, acute trauma, orthopedic surgery, neurosurgery, pediatric surgery, and other perioperative settings continue. The aim of this review is to provide an update on the current applications and limitations of TXA use in the perioperative period. (Anesth Analg 2022;135:460-73)

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Tranexamic acid and obstetric hemorrhage: give empirically or selectively?

Cited by 21 publications

References 85 publications

Management of severe peri-operative bleeding: Guidelines from the European Society of Anaesthesiology and Intensive Care

Management of severe peri-operative bleeding: Guidelines from the European Society of Anaesthesiology and Intensive Care

Evaluating tranexamic acid for the prevention and treatment of obstetric hemorrhage

Update on Applications and Limitations of Perioperative Tranexamic Acid

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