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

被引：7

作者：

Sentilhes, Loic ^{[1
]}

Madar, Hugo ^{[1
]}

Le Lous, Maela ^{[2
]}

Senat, Marie Victoire ^{[3
]}

Winer, Norbert ^{[4
,5
,6
]}

Rozenberg, Patrick ^{[7
]}

Kayem, Gilles ^{[8
,9
]}

Verspyck, Eric ^{[10
]}

Fuchs, Florent ^{[11
,12
]}

Azria, Elie ^{[8
,13
]}

Gallot, Denis ^{[14
]}

Korb, Diane ^{[15
]}

Desbriere, Raoul ^{[16
]}

Le Ray, Camille ^{[8
,17
]}

Chauleur, Celine ^{[18
]}

de Marcillac, Fanny ^{[19
]}

Perrotin, Franck ^{[20
]}

Parant, Olivier ^{[21
]}

Salomon, Laurent J. ^{[22
]}

Gauchotte, Emilie ^{[23
]}

Bretelle, Florence ^{[24
]}

Sananes, Nicolas ^{[25
]}

Bohec, Caroline ^{[26
]}

Mottet, Nicolas ^{[27
]}

Legendre, Guillaume ^{[28
]}

Letouzey, Vincent ^{[29
]}

Haddad, Bassam ^{[30
]}

Vardon, Delphine ^{[31
]}

Mattuizzi, Aurelien ^{[1
]}

Froeliger, Alizee ^{[1
]}

Bouchghoul, Hanane ^{[1
]}

Daniel, Valerie ^{[32
]}

Regueme, Sophie ^{[33
]}

Roussillon, Caroline ^{[34
]}

Georget, Aurore ^{[35
]}

Darsonval, Astrid ^{[32
]}

Benard, Antoine ^{[35
]}

Deneux-Tharaux, Catherine ^{[8
]}

机构：

[1] Bordeaux Univ Hosp, Dept Obstet & Gynecol, Bordeaux, France

[2] Rennes Univ Hosp, Dept Obstet & Gynecol, Rennes, France

[3] Bicetre Univ Hosp, Assistance Publ Hop Paris, Dept Obstet & Gynecol, Paris, France

[4] Univ Hosp Nantes, Dept Obstet & Gynecol, Univ Med Ctr Nantes, Ctr Invest Clin Mere Enfant, Nantes, France

[5] Univ Nantes, Unite Mixte Rech 1280, Physiol Nutr Adaptat, Natl Inst Agr Res,Inst Digest Dis, Nantes, France

[6] Ctr Rech Nutr Humaine Ouest, Nantes, France

[7] Poissy St Germain Hosp, Dept Obstet & Gynecol, Poissy, France

[8] Univ Paris, Univ Hosp Dept Risks Pregnancy, Inst Natl Rech Agron,Obstet Perinatal & Pediat Ep, Inst Natl Sante & Rech Med,Ctr Rech Epidemiol & S, Paris, France

[9] Trousseau Hosp, Assistance Publ Hop Paris, Dept Obstet & Gynecol, Paris, France

[10] Rouen Univ Hosp, Dept Obstet & Gynecol, Rouen, France

[11] Montpellier Univ Hosp, Dept Obstet & Gynecol, Villejuif, France

[12] Inst Natl Sante & Rech Med, Ctr Res Epidemiol & Populat Hlth, Reprod & Child Dev, U1018, Villejuif, France

[13] Paris Descartes Univ, Paris St Joseph Hosp, Matern Unit, Paris, France

[14] Clermont Ferrand Univ Hosp, Dept Obstet & Gynecol, Clermont Ferrand, France

[15] Robert Debre Hosp, Assistance Publ Hop Paris, Dept Obstet & Gynecol, Paris, France

[16] St Joseph Hosp, Dept Obstet & Gynecol, Marseille, France

[17] Univ Paris, Cochin Hosp, Assistance Publ Hop Paris, Port Royal Matern Unit,Fighting Prematur Univ Hos, Paris, France

[18] St Etienne Univ Hosp, Dept Obstet & Gynecol, St Etienne, France

[19] Univ Hosp Strasbourg, Dept Obstet & Gynecol, Strasbourg, France

[20] Tours Univ Hosp, Dept Obstet & Gynecol, Tours, France

[21] Toulouse Univ Hosp, Dept Obstet & Gynecol, Toulouse, France

[22] Necker Enfants Malad Hosp, Assistance Publ Hop Paris, Dept Obstet & Gynecol, Paris, France

[23] Nancy Univ Hosp, Dept Obstet & Gynecol, Nancy, France

[24] Aix Marseille Univ, Assistance Publ Hop Marseille, Dept Obstet & Gynecol, Marseille, France

[25] Hop Ctr Med Chirurg & Obstetr, Dept Obstet & Gynecol, Schiltigheim, France

[26] Francois Mitterrand Hosp, Dept Obstet & Gynecol, Pau, France

[27] Besancon Univ Hosp, Dept Obstet & Gynecol, Besancon, France

[28] Angers Univ Hosp, Dept Obstet & Gynecol, Angers, France

[29] Caremeau Univ Hosp, Dept Obstet & Gynecol, Nimes, France

[30] Univ Paris Est Creteil, Ctr Hosp Intercommunal Creteil, Dept Obstet Gynecol & Reprod Med, Creteil, France

[31] Caen Univ Hosp, Dept Obstet & Gynecol, Caen, France

[32] Brest Univ Hosp, Prod Pharmaceut Rech Inst Grand Ouest, Brest, France

[33] Bordeaux Univ Hosp, Dept Clin Res & Innovat, Bordeaux, France

[34] Bordeaux Univ Hosp, Dept Clin Res & Innovat, French Clin Res Infrastruct Network, European Clin Trials Platform & Dev, Bordeaux, France

[35] Ctr Hosp Univ Bordeaux, Publ Hlth Dept, Epidemiol Unit, Bordeaux, France

来源：

AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY | 2022年 / 227卷 / 06期

关键词：

blood loss; cesarean delivery; multiple pregnancy; postpartum hemorrhage; prevention; tranexamic acid; PLACEBO-CONTROLLED-TRIAL; METAANALYSIS; GUIDELINES; LEVEL; RISK;

D O I：

10.1016/j.ajog.2022.06.019

中图分类号：

R71 [妇产科学];

学科分类号：

100211 ;

摘要：

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 losserelated outcomes.

引用

页码：889.e1 / 889.e17

页数：17

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