|Year : 2015 | Volume
| Issue : 1 | Page : 25-26
Tranexamic acid in lower segment cesarean section and postpartum hemorrhage
Department of Anaesthesiology, Deen Dayal Upadhyay Hospital, New Delhi, India
|Date of Web Publication||8-Jan-2015|
153, New Ashiana Apartments, Plot - 10, Sector - 6, Dwarka, New Delhi - 110 075
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Goswami U. Tranexamic acid in lower segment cesarean section and postpartum hemorrhage. Med J DY Patil Univ 2015;8:25-6
Tranexamic acid (TXA) is an antifibrinolytic agent and a lysine analog,  which has been used to reduce blood loss in a variety of settings and surgeries with a varied dose range from 1 mg/kg to more than 100 mg/kg.  TXA is widely in use in the field of obstetrics. Both antepartum and postpartum hemorrhage (PPH) are being treated by TXA extensively. Ducloy-Bouthors et al. demonstrated for the first time that TXA administered to women with overt PPH decreases blood loss and maternal morbidity. 
It is important to remember that TXA is useful in settings where hyperfibrinolysis is the basis of bleeding.  Placental separation is a state of hyperfibrinolysis. The WHO estimates that PPH is the leading cause of maternal mortality worldwide with a prevalence rate of 6%. In Africa and Asia, where most maternal deaths occur, PPH accounts for more than 30% of all maternal deaths.  As mentioned in the article "Role of tranexamic acid in reducing blood loss during and after cesarean section" in this issue, the World Maternal Antifibrinolytic Trial  has been conducted to determine the effect of early administration of TXA on mortality and morbidity in women with PPH. The drug has been shown by various authors to be cost-effective as well.  Hence, there surely is scope for using safe and cost-effective drugs like TXA in reducing PPH and its ill-effects.
Its use in the setting of lower segment cesarean section (LSCS) has been studied by various workers with a favorable outcome. [2,8-10] This may prove to be of importance both for reducing intraoperative bleed and also to prevent PPH. The percentage of cases going for LSCS delivery is getting higher by the day. The cesarean birth rate in the United States is now approximately 30% of all live births.  Developing countries like India are not far behind. A loss of up to 800-1000 ml is seen on an average during LSCS  and about 5% of women undergoing LSCS receive a blood transfusion.  This could be a significant cause of burden to the blood banks and health care system as a whole. The adverse effects of blood and blood products transfusion should also be kept in mind. One study done in anemic parturients undergoing LSCS showed the blood sparing effect of this drug with no adverse events.  With anemia being so rampant in developing countries like India, TXA could prove to be an effective drug in the armamentarium of blood sparing agents to reduce transfusion, morbidity, and mortality in cases of LSCS and PPH.
| References|| |
Ortmann E, Besser MW, Klein AA. Antifibrinolytic agents in current anaesthetic practice. Br J Anaesth 2013;111:549-63.
Goswami U, Sarangi S, Gupta S, Babbar S. Comparative evaluation of two doses of tranexamic acid used prophylactically in anemic parturients for lower segment cesarean section: A double-blind randomized case control prospective trial. Saudi J Anaesth 2013;7:427-31.
Ducloy-Bouthors AS, Jude B, Duhamel A, Broisin F, Huissoud C, Keita-Meyer H, et al
. High-dose tranexamic acid reduces blood loss in postpartum haemorrhage. Crit Care 2011;15:R117.
McCormack PL. Tranexamic acid: A review of its use in the treatment of hyperfibrinolysis. Drugs 2012;72:585-617.
Fawole B, Awolude OA, Adeniji AO, Onafowokan O. WHO recommendations for the prevention of postpartum haemorrhage: RHL guideline (last revised: 1 May 2010). The WHO Reproductive Health Library; Geneva: World Health Organization.
Shakur H, Elbourne D, Gülmezoglu M, Alfirevic Z, Ronsmans C, Allen E, et al
. The WOMAN trial (World Maternal Antifibrinolytic Trial): Tranexamic acid for the treatment of postpartum haemorrhage: An international randomised, double blind placebo controlled trial. Trials 2010;11:40.
Guerriero C, Cairns J, Perel P, Shakur H, Roberts I, CRASH 2 trial collaborators. Cost-effectiveness analysis of administering tranexamic acid to bleeding trauma patients using evidence from the CRASH-2 trial. PLoS One 2011;6:e18987.
Gai MY, Wu LF, Su QF, Tatsumoto K. Clinical observation of blood loss reduced by tranexamic acid during and after caesarian section: A multi-center, randomized trial. Eur J Obstet Gynecol Reprod Biol 2004;112:154-7.
Sekhavat L, Tabatabaii A, Dalili M, Farajkhoda T, Tafti AD. Efficacy of tranexamic acid in reducing blood loss after cesarean section. J Matern Fetal Neonatal Med 2009;22:72-5.
Gohel M, Patel P, Gupta A, Desai P. Efficacy of tranexamic acid in decreasing blood loss during and after caesarean section: A randomized case controlled prospective study. Obstet Gynaecol India 2007;57:227-30.
Birnbach DJ, Browne IM. Anesthesia for obstetrics. Miller's Anesthesia. 7 th
ed., Ch. 69. Philadelphia: Churchill Livingstone Elsevier; 2010.
Healy TE, Knight PR. Obstetric Anaesthesia. Wylie and Churchill-Davidson's A Practice of Anaesthesia. 7 th
ed. London: Arnold; 2003.
Ekeroma AJ, Ansari A, Stirrat GM. Blood transfusion in obstetrics and gynaecology. Br J Obstet Gynaecol 1997;104:278-84.