Tranexamic acid for the prevention of blood loss after cesarean among women with twins: a secondary analysis of the TRAnexamic Acid for Preventing Postpartum Hemorrhage Following a Cesarean Delivery randomized clinical trial - INRAE - Institut national de recherche pour l’agriculture, l’alimentation et l’environnement Access content directly
Journal Articles American Journal of Obstetrics and Gynecology Year : 2022

Tranexamic acid for the prevention of blood loss after cesarean among women with twins: a secondary analysis of the TRAnexamic Acid for Preventing Postpartum Hemorrhage Following a Cesarean Delivery randomized clinical trial

1 CHU Bordeaux
2 Centre Hospitalier Universitaire de Rennes [CHU Rennes] = Rennes University Hospital [Ponchaillou]
3 Hôpital Bicêtre [AP-HP, Le Kremlin-Bicêtre]
4 PhAN - Physiopathologie des Adaptations Nutritionnelles
5 CHU Nantes - Centre Hospitalier Universitaire de Nantes = Nantes University Hospital
6 Centre hospitalier intercommunal de Poissy/Saint-Germain-en-Laye - CHIPS [Poissy]
7 RISCQ - Risques cliniques et sécurité en santé des femmes et en santé périnatale
8 INSERM - Institut National de la Santé et de la Recherche Médicale
9 CHU Rouen
10 CESP - Centre de recherche en épidémiologie et santé des populations
11 CHRU Montpellier - Centre Hospitalier Régional Universitaire [Montpellier]
12 IDESP - Institut Desbrest de santé publique
13 CHU Clermont-Ferrand
14 AP-HP Hôpital universitaire Robert-Debré [Paris]
15 Hôpital Saint-Joseph [Marseille]
16 Hôpital Cochin [AP-HP]
17 CHU ST-E - Centre Hospitalier Universitaire de Saint-Etienne [CHU Saint-Etienne]
18 CHU Strasbourg - Centre Hospitalier Universitaire [Strasbourg]
19 CHU Trousseau [Tours]
20 CHU Toulouse - Centre Hospitalier Universitaire de Toulouse
21 Equipe SPHERE (CERPOP)
22 INEM - UM 111 (UMR 8253 / U1151) - Institut Necker Enfants-Malades
23 CHRU Nancy - Centre Hospitalier Régional Universitaire de Nancy
24 APHM - Assistance Publique - Hôpitaux de Marseille
25 Service de Gynécologie Obstétrique [CHRU Besançon]
26 CHU Angers - Centre Hospitalier Universitaire d'Angers
27 CHU Nîmes - Centre Hospitalier Universitaire de Nîmes
28 IBMM - Institut des Biomolécules Max Mousseron [Pôle Chimie Balard]
29 CHI Créteil
30 CHU Caen
31 CIC Brest
32 BPH - Bordeaux population health
33 EPOPé [CRESS - U1153 / UMR_A 1125] - Obstetrical, Perinatal and Pediatric Epidemiology | Épidémiologie Obstétricale, Périnatale et Pédiatrique
Loïc Sentilhes
Hugo Madar
  • Function : Author
Eric Verspyck
  • Function : Author
Nicolas Sananès
  • Function : Author
Caroline Bohec
  • Function : Author
Bassam Haddad
  • Function : Author
Delphine Vardon
  • Function : Author
Aurélien Mattuizzi
  • Function : Author
Alizée Froeliger
  • Function : Author
Hanane Bouchghoul
  • Function : Author
Valérie Daniel
  • Function : Author
Sophie Regueme
  • Function : Author
Caroline Roussillon
  • Function : Author
Aurore Georget
  • Function : Author

Abstract

Background: Although prophylactic tranexamic acid administration after cesarean delivery resulted in a lower incidence of calculated estimated blood loss of >1000 mL or red cell transfusion by day 2, its failure to reduce the incidence of hemorrhage-related secondary clinical outcomes (TRAnexamic Acid for Preventing Postpartum Hemorrhage Following a Cesarean Delivery trial) makes its use questionable. The magnitude of its effect may differ in women at higher risk of blood loss, including those with multiple pregnancies. Objective: This study aimed to compare the effect of tranexamic acid vs placebo to prevent blood loss after cesarean delivery among women with multiple pregnancies. Study design: This was a secondary analysis of the TRAnexamic Acid for Preventing Postpartum Hemorrhage Following a Cesarean Delivery trial data, a double-blind, randomized controlled trial from March 2018 to January 2020 in 27 French maternity hospitals, that included 319 women with multiple pregnancies. Women with a cesarean delivery before or during labor at ≥34 weeks of gestation were randomized to receive intravenously 1 g of tranexamic acid (n=160) or placebo (n=159), both with prophylactic uterotonics. The primary outcome was a calculated estimated blood loss of >1000 mL or a red blood cell transfusion by 2 days after delivery. The secondary outcomes included clinical and laboratory blood loss measurements. Results: Of the 4551 women randomized in this trial, 319 had a multiple pregnancy and cesarean delivery, and 298 (93.4%) had primary outcome data available. This outcome occurred in 62 of 147 women (42.2%) in the tranexamic acid group and 67 of 152 (44.1%) receiving placebo (adjusted risk ratio, 0.97; 95% confidence interval, 0.68-1.38; P=.86). No significant between-group differences occurred for any hemorrhage-related clinical outcomes: gravimetrically estimated blood loss, provider-assessed clinically significant hemorrhage, additional uterotonics, postpartum blood transfusion, arterial embolization, and emergency surgery (P>.05 for all comparisons). Conclusion: Among women with a multiple pregnancy and cesarean delivery, prophylactic tranexamic acid did not reduce the incidence of any blood loss-related outcomes.

Dates and versions

hal-03979406 , version 1 (08-02-2023)

Identifiers

Cite

Loïc Sentilhes, Hugo Madar, Maëla Le Lous, Marie-Victoire Senat, Norbert Winer, et al.. Tranexamic acid for the prevention of blood loss after cesarean among women with twins: a secondary analysis of the TRAnexamic Acid for Preventing Postpartum Hemorrhage Following a Cesarean Delivery randomized clinical trial. American Journal of Obstetrics and Gynecology, 2022, 227 (6), pp.889.e1-889.e17. ⟨10.1016/j.ajog.2022.06.019⟩. ⟨hal-03979406⟩
37 View
4 Download

Altmetric

Share

Gmail Facebook X LinkedIn More