TY - JOUR
T1 - The effect of tranexamic acid on blood loss and maternal outcome in the treatment of persistent postpartum hemorrhage
T2 - A nationwide retrospective cohort study
AU - Gillissen, Ada
AU - Henriquez, Dacia D C A
AU - van den Akker, Thomas
AU - Caram-Deelder, Camila
AU - Wind, Merlijn
AU - Zwart, Joost J
AU - van Roosmalen, Jos
AU - Eikenboom, Jeroen
AU - Bloemenkamp, Kitty W M
AU - van der Bom, Johanna G
N1 - Publisher Copyright:
© 2017 Gillissen et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
PY - 2017/11
Y1 - 2017/11
N2 - BACKGROUND: Recent results show a protective effect of tranexamic acid on death due to bleeding in patients with postpartum hemorrhage in low- and middle-resource countries. We quantify the association between early administration of tranexamic acid compared to late or no administration and severe acute maternal morbidity and blood loss among women suffering from persistent severe postpartum hemorrhage in a high-income country.METHODS AND FINDINGS: We performed a nationwide retrospective cohort study in 61 hospitals in the Netherlands. The study population consisted of 1260 women with persistent postpartum hemorrhage who had received at least four units of red cells, or fresh frozen plasma or platelets in addition to red cells. A review of medical records was performed and cross-referenced with blood bank data. The composite endpoint comprised maternal morbidity (hysterectomy, ligation of the uterine arteries, emergency B-Lynch suture, arterial embolization or admission into an intensive care unit) and mortality.RESULTS: 247 women received early tranexamic acid treatment. After adjustment for confounding, odds ratio for the composite endpoint for early tranexamic acid (n = 247) versus no/late tranexamic acid (n = 984) was 0.92 (95% confidence interval (CI) 0.66 to 1.27). Propensity matched analysis confirmed the absence of a difference between women with and without tranexamic acid. Blood loss after administration of first line therapy did not differ significantly between the two groups (adjusted difference -177 mL, CI -509.4 to +155.0).CONCLUSIONS: Our findings suggest that in a high-resource country the effect of tranexamic acid on both blood loss and the combined endpoint of maternal mortality and morbidity may be disappointing.
AB - BACKGROUND: Recent results show a protective effect of tranexamic acid on death due to bleeding in patients with postpartum hemorrhage in low- and middle-resource countries. We quantify the association between early administration of tranexamic acid compared to late or no administration and severe acute maternal morbidity and blood loss among women suffering from persistent severe postpartum hemorrhage in a high-income country.METHODS AND FINDINGS: We performed a nationwide retrospective cohort study in 61 hospitals in the Netherlands. The study population consisted of 1260 women with persistent postpartum hemorrhage who had received at least four units of red cells, or fresh frozen plasma or platelets in addition to red cells. A review of medical records was performed and cross-referenced with blood bank data. The composite endpoint comprised maternal morbidity (hysterectomy, ligation of the uterine arteries, emergency B-Lynch suture, arterial embolization or admission into an intensive care unit) and mortality.RESULTS: 247 women received early tranexamic acid treatment. After adjustment for confounding, odds ratio for the composite endpoint for early tranexamic acid (n = 247) versus no/late tranexamic acid (n = 984) was 0.92 (95% confidence interval (CI) 0.66 to 1.27). Propensity matched analysis confirmed the absence of a difference between women with and without tranexamic acid. Blood loss after administration of first line therapy did not differ significantly between the two groups (adjusted difference -177 mL, CI -509.4 to +155.0).CONCLUSIONS: Our findings suggest that in a high-resource country the effect of tranexamic acid on both blood loss and the combined endpoint of maternal mortality and morbidity may be disappointing.
KW - Adult
KW - Female
KW - Humans
KW - Postpartum Hemorrhage/prevention & control
KW - Pregnancy
KW - Pregnancy Outcome
KW - Retrospective Studies
KW - Tranexamic Acid/administration & dosage
UR - http://www.scopus.com/inward/record.url?scp=85033500787&partnerID=8YFLogxK
U2 - 10.1371/journal.pone.0187555
DO - 10.1371/journal.pone.0187555
M3 - Article
C2 - 29107951
SN - 1932-6203
VL - 12
SP - e0187555
JO - PLoS ONE
JF - PLoS ONE
IS - 11
M1 - e0187555
ER -