National trends in tranexamic acid use in the peripartum period, 2015-2019.
Adult
Antifibrinolytic Agents
/ adverse effects
Female
Humans
Peripartum Period
Postpartum Hemorrhage
/ chemically induced
Pregnancy
Pregnancy Complications, Cardiovascular
/ drug therapy
Retrospective Studies
Tranexamic Acid
/ adverse effects
United States
/ epidemiology
Venous Thromboembolism
/ drug therapy
Young Adult
Perinatal outcomes
Postpartum hemorrhage
Tranexamic acid
Venous thromboembolism
Journal
Journal of thrombosis and thrombolysis
ISSN: 1573-742X
Titre abrégé: J Thromb Thrombolysis
Pays: Netherlands
ID NLM: 9502018
Informations de publication
Date de publication:
Oct 2020
Oct 2020
Historique:
pubmed:
27
5
2020
medline:
5
8
2021
entrez:
27
5
2020
Statut:
ppublish
Résumé
The purpose of this study was to measure trends in the use of tranexamic acid (TXA) during delivery in the United States and to evaluate demographic data and morbidity outcomes among these patients. This retrospective cohort study includes data from 19 hospitals in the Universal Health Services network. We compared rates of TXA use between January 2015 and June 2019 across geographic sectors. We also evaluated associations of demographic variables and perinatal outcomes of women who received TXA. 209 cases of TXA use were found from analysis of 101,564 deliveries. TXA use increased over time and rates were higher in the West than in Central and East; the slope of increase over years did not differ between regions. Women who received TXA were more likely to have a history of postpartum hemorrhage (59 (28.2%) vs. 2290 (2.2%), P < 0.0001) but were not more likely to have a chronic disease, including diabetes mellitus, hypertension and heart disease. Women who received TXA were more likely to have estimated blood loss greater than or equal to 1000 mL (adjusted odds ratio (aOR) 15.3; 95% CI 11.1-21.1; P < 0.0001). Likelihood of venous thromboembolism was not significantly increased in TXA recipients (aOR 2.0; 95% CI 0.3-14.6; P = 0.49). Increasing national trends of TXA use in the peripartum period was observed, with variable increases by geographic region. Likelihood of venous thromboembolism was not significantly increased among women who received TXA. Increasing TXA use throughout the country suggests that updated hemorrhage guidelines from national obstetrical organizations can shape clinical practice.
Sections du résumé
BACKGROUND
BACKGROUND
The purpose of this study was to measure trends in the use of tranexamic acid (TXA) during delivery in the United States and to evaluate demographic data and morbidity outcomes among these patients.
METHODS
METHODS
This retrospective cohort study includes data from 19 hospitals in the Universal Health Services network. We compared rates of TXA use between January 2015 and June 2019 across geographic sectors. We also evaluated associations of demographic variables and perinatal outcomes of women who received TXA.
RESULTS
RESULTS
209 cases of TXA use were found from analysis of 101,564 deliveries. TXA use increased over time and rates were higher in the West than in Central and East; the slope of increase over years did not differ between regions. Women who received TXA were more likely to have a history of postpartum hemorrhage (59 (28.2%) vs. 2290 (2.2%), P < 0.0001) but were not more likely to have a chronic disease, including diabetes mellitus, hypertension and heart disease. Women who received TXA were more likely to have estimated blood loss greater than or equal to 1000 mL (adjusted odds ratio (aOR) 15.3; 95% CI 11.1-21.1; P < 0.0001). Likelihood of venous thromboembolism was not significantly increased in TXA recipients (aOR 2.0; 95% CI 0.3-14.6; P = 0.49).
CONCLUSION
CONCLUSIONS
Increasing national trends of TXA use in the peripartum period was observed, with variable increases by geographic region. Likelihood of venous thromboembolism was not significantly increased among women who received TXA. Increasing TXA use throughout the country suggests that updated hemorrhage guidelines from national obstetrical organizations can shape clinical practice.
Identifiants
pubmed: 32451824
doi: 10.1007/s11239-020-02141-4
pii: 10.1007/s11239-020-02141-4
pmc: PMC7529751
mid: NIHMS1597803
doi:
Substances chimiques
Antifibrinolytic Agents
0
Tranexamic Acid
6T84R30KC1
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
746-752Subventions
Organisme : NHLBI NIH HHS
ID : K23 HL141640
Pays : United States
Organisme : NHLBI NIH HHS
ID : K23HL141640
Pays : United States
Organisme : NHLBI NIH HHS
ID : K23HL141640
Pays : United States
Références
Say L, Chou D, Gemmill A, Tunçalp Ö, Moller AB, Daniels J et al (2014) Global causes of maternal death: a WHO systematic analysis. Lancet Glob Health. https://doi.org/10.1016/S2214-109X(14)70227-X
doi: 10.1016/S2214-109X(14)70227-X
pubmed: 25103383
Main EK, Goffman BM, Kane LK, Fontaine PL, Gorlin JB, Lagrew DC, Levy BS (2016) National partnership for maternal safety: consensus bundle on obstetric hemorrhage. Obstet Anesth Digest 36(2):88. https://doi.org/10.1097/01.aoa.0000482622.40786.7b
doi: 10.1097/01.aoa.0000482622.40786.7b
Shakur H, Roberts I, Fawole B, Chaudhri R, El-Sheikh M, Akintan A et al (2017) 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 389(10084):2105–2116. https://doi.org/10.1016/S0140-6736(17)30638-4
doi: 10.1016/S0140-6736(17)30638-4
American College of Obstetricians and Gynecologists (ACOG) (2017) Postpartum hemorrhage. ACOG practice Bulletin No. 183. Obstet Gynecol 130(4):e168–e186. https://doi.org/10.1097/AOG.0000000000002351
doi: 10.1097/AOG.0000000000002351
Friedman AM, Ananth CV, Huang Y, D’Alton ME, Wright JD (2016) Hospital delivery volume, severe obstetrical morbidity, and failure to rescue. Am J Obstet Gynecol 215(6):e1–795. https://doi.org/10.1016/j.ajog.2016.07.039
doi: 10.1016/j.ajog.2016.07.039
Ahmadzia HK, Phillips JM, Katler QS, James AH (2018) Tranexamic acid for prevention and treatment of postpartum hemorrhage: an update on management and clinical outcomes. Obstet Gynecol Surv 73(10):587–594. https://doi.org/10.1097/OGX.0000000000000597
doi: 10.1097/OGX.0000000000000597
pubmed: 30379320
Sullivan JT (2017) The expanding role of tranexamic acid in the management of obstetric hemorrhage. J Thorac Dis 9(8):2251–2254. https://doi.org/10.21037/jtd.2017.07.19
doi: 10.21037/jtd.2017.07.19
pubmed: 28932517
pmcid: 5594136
Ghazi S, Pierson R, Torlinski T (2013) Military application of tranexamic acid in trauma emergency resuscitation study. Media War Confl 14(1):86–88. https://doi.org/10.1177/175114371301400118
doi: 10.1177/175114371301400118
Sukeik M, Alshryda S, Haddad FS, Mason JM (2011) Systematic review and meta-analysis of the use of tranexamic acid in total hip replacement. J Bone Jt Surg Br 93-B(1):39–46. https://doi.org/10.1302/0301-620X.93B1.24984
doi: 10.1302/0301-620X.93B1.24984
Williams-Johnson JA, McDonald AH, Strachan GG, Williams EW (2010) Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2) a randomised, placebo-controlled trial. West Indian Med J 59(6):612–624
pubmed: 21702233
Nishida T, Kinoshita T, Yamakawa K (2017) Tranexamic acid and trauma-induced coagulopathy. J Intensive Car. https://doi.org/10.1186/s40560-016-0201-0
doi: 10.1186/s40560-016-0201-0
Shaylor R, Weiniger CF, Austin N, Tzabazis A, Shander A, Goodnough LT, Butwick AJ (2017) National and international guidelines for patient blood management in obstetrics: a qualitative review. Anesth Analg 124(1):216–232. https://doi.org/10.1213/ANE.0000000000001473
doi: 10.1213/ANE.0000000000001473
pubmed: 27557476
pmcid: 5161642
Abdul-Kadir R, McLintock C, Ducloy A-S, El-Refaey H, England A, Federici AB et al (2014) Evaluation and management of postpartum hemorrhage: consensus from an international expert panel. Transfusion 54(7):1756–1768. https://doi.org/10.1111/trf.12550
doi: 10.1111/trf.12550
pubmed: 24617726
Vogel JP, Oladapo OT, Dowswell T, Gülmezoglu AM (2018) Updated WHO recommendation on intravenous tranexamic acid for the treatment of post-partum haemorrhage. Lancet Glob Health 6(1):e18–e19. https://doi.org/10.1016/S2214-109X(17)30428-X
doi: 10.1016/S2214-109X(17)30428-X
pubmed: 29100880