The Efficacy of Intravenous Tranexamic Acid in Reduction of Blood Loss in Women at High Risk of Postpartum Hemorrhage

Abstract Background Postpartum hemorrhage (PPH) is the leading cause of maternal mortality. All women who carry a pregnancy beyond 20 weeks’ gestation are at risk for PPH and its sequelae. Although maternal mortality rates have declined greatly in the developed world, PPH remains a leading cause of maternal mortality elsewhere. Aim of the Work To assess the efficacy and safety intravenous tranexamic acid in reduction of amount of blood loss in high risk women who deliver by cesarean section or vaginal delivery in postpartum period. Patients and Methods This prospective double blind randomized controlled clinical trial study was conducted on 200 patients planned for LSCS or vaginal delivery at Gestational Age ≥ 34 Weeks at Ain Shams University Maternity Hospital. Recruitment of data begun once the protocol was approved by research and ethical committee of the department of obstetrics and gynecology. Results No significant difference between Study and Control groups as regards age (p = 0.508), no significant difference between Study and Control groups as regards Gestational age (p = 0.447),total blood loss (p < 0.001) was significantly lower in study group than control group, Vaginal pads in the 1st 24 hours post-partum was significantly less soaked in study group than control group (p < 0.001). no significant difference between Study and Control groups as regards Preoperative Hemoglobin, Postoperative Hemoglobin was significantly higher in study group than control group (p < 0.001), Reduction in Hemoglobin was significantly less in study group than control group (p < 0.001), no significant difference between Study and Control groups as regards Preoperative Hematocrite, Postoperative Hematocrit was significantly higher in study group than control group (p < 0.001), Reduction in Hematocrite was significantly less in study group than control group (p < 0.001).Need to iron replacement or blood transfusion was significantly less frequent in study group than control group (p = 0.24). Conclusion The use of tranexamic acid prior to cesarean section or vaginal delivery is effective as a prophylaxis against post-partum hemorrhage as shown by the results of this study. It can significantly reduce blood loss during and after cesarean section or vaginal delivery.

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Assessment the role of tranexamic acid in prevention of postpartum hemorrhage

Ain-Shams Journal of Anesthesiology ◽

10.1186/s42077-021-00154-6 ◽

2021 ◽

Vol 13 (1) ◽

Author(s):

Nevein Gerges Fahmy ◽

Fahmy Saad Latif Eskandar ◽

Walid Albasuony Mohammed Ahmed Khalil ◽

Mohammed Ibrahim Ibrahim Sobhy ◽

Amin Mohammed Al Ansary Amin

Keyword(s):

Blood Loss ◽

Cesarean Section ◽

Tranexamic Acid ◽

Postpartum Hemorrhage ◽

Postoperative Bleeding ◽

Control Group ◽

Study Group ◽

Mortality And Morbidity ◽

Lower Segment Cesarean Section ◽

Prophylactic Use

Abstract Background Postpartum hemorrhage (PPH) is one of the leading causes of maternal mortality and morbidity worldwide. It is believed that hemostatic imbalance secondary to release of tissue plasminogen activator (tPA) and subsequent hyperfibrinolysis plays a major role in PPH pathogenesis. Antifibrinolytic drugs such as tranexamic acid (TXA) are widely used in hemorrhagic conditions associated with hyperfibrinolysis. TXA reduced maternal death due to PPH and its use as a part of PPH treatment is recommended, and in recent years, a number of trials have investigated the efficacy of prophylactic use of TXA in reducing the incidence and the severity of PPH. The study is aiming to assess the efficacy of tranexamic acid in reducing blood loss throughout and after the lower segment cesarean section and reducing the risk of postpartum hemorrhage. Results The amount of blood loss was significantly lower in the study group than the control group (416.12±89.95 and 688.68±134.77 respectively). Also the 24-h postoperative hemoglobin was significantly higher in the study group (11.66±0.79 mg/dl) compared to the control group (10.53±1.07mg/dl), and the 24-h postoperative hematocrit value was significantly higher in the study group (34.99±2.40) compared to control (31.62±3.22). Conclusion Prophylactic administration of tranexamic acid reduces intraoperative and postoperative bleeding in cesarean section and the incidence of postpartum hemorrhage.

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Perioperative blood loss in total hip and knee arthroplasty: Outcomes associated with intravenous tranexamic acid use in an academic medical center

SAGE Open Medicine ◽

10.1177/2050312116637024 ◽

2016 ◽

Vol 4 ◽

pp. 205031211663702 ◽

Cited By ~ 16

Author(s):

Craig A Hogan ◽

Larry K Golightly ◽

Suzanne Phong ◽

Michael R Dayton ◽

Clark Lyda ◽

...

Keyword(s):

Treatment Group ◽

Blood Loss ◽

Confidence Interval ◽

Tranexamic Acid ◽

Knee Arthroplasty ◽

Control Group ◽

Control Groups ◽

Joint Replacement Surgery ◽

Replacement Surgery ◽

And Control

Objectives: Clinical trials have reported decreased blood loss with the use of tranexamic acid during joint reconstruction. The purpose of this study was to assess the individual practice implications of tranexamic acid use in joint replacement surgery. Methods: Health records of adults undergoing total knee arthroplasty and total hip arthroplasty over a 12-month period were retrospectively reviewed. The treatment group comprised patients who received intravenous tranexamic acid perioperatively. The control group comprised patients who did not receive tranexamic acid. Results: Patients in the treatment group (n = 64) and the control group (n = 99) were well matched for demographics, orthopedic diagnosis, and comorbidities. In-hospital postsurgical mean decreases in hemoglobin concentrations were −4.05 g/dL and −4.94 g/dL in the treatment and control groups, respectively (p < 0.001). Postsurgical mean decreases in hematocrit levels were −11.2% and −14.2% in the treatment and control groups, respectively (p < 0.001). Three patients in the treatment group (5%) and 21 patients in the control group (21%) received red blood cell transfusions (p = 0.006). As compared to control, the relative risk of transfusion in the treatment group was 0.23 (95% confidence interval = 0.07–0.76) and the number needed to treat to avoid one transfusion was 7.0 (95% confidence interval = 3.8–14.4). No evidence of thromboembolism or other serious complications were observed in either group. Conclusions: In patients undergoing joint replacement surgery, perioperative administration of tranexamic acid was associated with diminished blood loss and lesser resource utilization.

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A Comparative Study of Relationship between Micronutrients and Gestational Diabetes

ISRN Obstetrics and Gynecology ◽

10.5402/2012/470419 ◽

2012 ◽

Vol 2012 ◽

pp. 1-4 ◽

Cited By ~ 14

Author(s):

Farideh Akhlaghi ◽

Seyyed Majid Bagheri ◽

Omid Rajabi

Keyword(s):

Gestational Diabetes ◽

Pregnant Women ◽

Gestational Age ◽

Control Group ◽

Study Group ◽

Inclusion Criteria ◽

Control Groups ◽

Significant Difference ◽

Micronutrient Concentration ◽

And Control

In this paper, we studied the relation between the micronutrient and gestational diabetes. Therefore, we measured micronutrient concentration including Ni, Al, Cr, Mg, Fe, Zn, Cu, and Se in serum of women with gestational diabetes between 24 and 28 weeks of gestational age (study group) who had inclusion criteria and comparison with micronutrient levels in normal pregnant women with same gestational age (control group). Results showed that there was no significant difference between the serum micronutrient level (Ni, Al, Cr, Mg, Zn, Cu, Se) in study and control groups except serum level of iron which in serum of gestational diabetic women was lower than normal pregnant women and difference was significant.

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Study of the efficacy of tranexamic acid in reducing blood loss after child birth

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20211502 ◽

2021 ◽

Vol 10 (5) ◽

pp. 1863

Author(s):

Nagajyothi Gunturu ◽

D. Shivani ◽

P. Sravanthi

Keyword(s):

Caesarean Section ◽

Blood Loss ◽

Tranexamic Acid ◽

Vaginal Delivery ◽

Active Management ◽

Control Group ◽

Study Group ◽

Lower Segment ◽

Lower Segment Caesarean Section ◽

Third Stage

Background: The aim was to study the efficacy of tranexamic acid in reducing blood loss after childbirth in normal vaginal delivery and LSCS.Methods: 200 pregnant women divided into two groups group 1 and group 2, 100 women undergoing LSCS and 100 women undergoing vaginal delivery. Study group will be given 1 g iv tranexamic acid along with active management of third stage of labor and control subjects will be given only active management of third stage. Clinical observations and laboratory examinations, measurement of blood loss were measured.Results: Distribution with respect to indication of LSCS like fetal distress, cephalopelvic disproportion, abnormal presentation, previous LSCS, arrest of descent, failed induction and onset of labor were comparable between both the groups. Study group showed marked decrease in blood loss when compared to controls from time of placental delivery to 2 hours postpartum in women undergoing vaginal delivery and caesarean section. There was a significant fall in mean Hb level among the control group when compared with the study group. There was no significant difference in the vital signs of the subjects in both the groups. The incidence of adverse effect like nausea, vomiting and diarrhoea were not increased in the study group when compared to the control group. Also the incidence of thrombosis was not increased with tranexamic acid.Conclusions: Tranexamic acid significantly reduced the amount of blood loss after vaginal delivery and lower segment caesarean section. Its use was not associated with any adverse drug reactions like nausea, vomiting, diarrhoea or thrombosis. Tranexamic acid can be safely administered in pregnant women undergoing vaginal delivery and lower segment caesarean section.

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Prophylactic use of tranexamic acid for reducing postpartum hemorrhage in vaginal delivery

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20211153 ◽

2021 ◽

Vol 10 (4) ◽

pp. 1654

Author(s):

Anusha Ginjupalli ◽

Anuradha S. N. ◽

Joshi Suyajna D.

Keyword(s):

Blood Pressure ◽

Blood Loss ◽

Tranexamic Acid ◽

Vaginal Delivery ◽

Pulse Rate ◽

Postpartum Hemorrhage ◽

Control Group ◽

Study Group ◽

Normal Delivery ◽

Number Of Patients

Background: The use of anti-fibrinolytic therapy has potential to reduce obstetric blood loss due to profound changes that take place in the fibrinolytic system during normal childbirth. Objective was to evaluate the efficacy of tranexamic acid in reducing postpartum hemorrhage (PPH) during normal labour.Methods: Patients who planned for normal delivery and fulfilling the inclusion criteria were recruited for the study. The pre-delivery parameters -pulse rate, blood pressure, Hb gm% and PCV% were measured for each patient. The study group received injection oxytocin (10 IU) and injection tranexamic acid (500 mg) slow intravenous route. The control group received injection oxytocin (10 IU) and placebo injection. Immediately after delivery of the anterior shoulder of the baby, when all the liquor was drained, Brasse-V drape is placed under the patient. Then the patient was given pre-weighed pads, which were weighed 2 hours post-partum. Final blood loss was calculated by combining amount of blood collected in the drape and blood absorbed by the pads.Results: The total number of patients studied was 300- equally distributed in both the groups. There was a significant increase in the pulse rate and decrease in blood pressure in the control group compared to the study group. The post-delivery haemoglobin and haematocrit were significantly reduced in the control group. The blood loss was significantly low in the study group. The need for other uterotonics, blood transfusion, and duration of hospital stay, were significantly low in study group.Conclusions: Tranexamic acid, when given prophylactically to the women with vaginal delivery who received prophylactic oxytocin, appears to reduce the blood loss effectively compared to placebo alone.

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Increased levels of circulating CD34+ cells in neovascular age-related macular degeneration: relation with clinical and OCT features

European Journal of Ophthalmology ◽

10.5301/ejo.5001012 ◽

2018 ◽

Vol 28 (1) ◽

pp. 80-86

Author(s):

Caner Kara ◽

Pınar Ç. Özdal ◽

Emrullah Beyazyıldız ◽

Nurgül E. Özcan ◽

Mehmet Y. Teke ◽

...

Keyword(s):

Stem Cells ◽

Stem Cell ◽

Macular Degeneration ◽

Age Related Macular Degeneration ◽

Control Group ◽

Study Group ◽

Control Groups ◽

Age Related ◽

Significant Difference ◽

And Control

Purpose: To investigate the levels of circulating CD34+ stem cells in patients with neovascular type age-related macular degeneration (AMD) and its relation with clinical and optical coherence tomography (OCT) findings. Methods: The study consisted of 55 patients: 28 patients (18 male and 10 female) with neovascular type AMD as a study group and 27 patients (12 male and 15 female) scheduled for cataract surgery as a control group. The level of CD34+ stem cells was measured by ﬂow cytometry. Demographic and clinical data were recorded. Results: The mean ages of patients in the study and control groups were 71 ± 8 and 68 ± 6 years, respectively. There was no statistically significant difference in terms of age, sex, or systemic disease association between study and control groups. However, smoking status was significantly higher in the study group (67.9% vs 37.0%; p = 0.02). Stem cell levels were significantly higher in the study group (1.5 ± 0.9 vs 0.5 ± 0.3; p<0.001), but there was no relation between stem cell levels and clinical and OCT findings. Conclusions: Increased circulating CD34+ stem cell levels were observed in patients with choroidal neovascular membrane associated with AMD, but no significant relation was found between cell levels and clinical and OCT findings.

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Effects of Tranexamic Acid on Mortality and Blood Transfusion in Trauma Patients with Significant Hemorrhage: A Clinical Trial

Advances in Bioscience and Clinical Medicine ◽

10.7575/aiac.abcmed.17.05.04.04 ◽

2017 ◽

Vol 5 (4) ◽

pp. 24

Author(s):

Farzad Kakaei ◽

Peyman Virani ◽

Shahriar Hashemzadeh ◽

Sina Zarrintan ◽

Samad Beheshtirouy ◽

...

Keyword(s):

Blood Transfusion ◽

Tranexamic Acid ◽

Study Groups ◽

Control Group ◽

Case Group ◽

Trauma Patients ◽

Transfusion Rate ◽

Control Groups ◽

Significant Difference ◽

And Control

Extensive hemorrhage is a significant cause of mortality in trauma patients. Tranexamic acid has been used for controlling bleeding in cardiovascular surgeries and dental manipulations in patients with hemophilia. However, in traumatic patients with bleeding, its use dates back to more recent years. This study aims to examine the effects of this drug on reducing mortality and blood transfusion rate in trauma patients with significant hemorrhage. A total of 60 patients with significant trauma-related hemorrhage (systolic blood pressure < 90 mmHg/heart rate > 110/min) from the emergency department of Imam Reza Hospital (Tabriz, Iran), were randomized in two groups. The case group received intravenous Tranexamic acid (1 g in 10 min and then 1 g over 8 h). The control group received placebo. Rate of transfusion and rate of one-month mortality were compared between the study groups. The mean ICU stay and overall hospitalization times did not have significant difference between two groups (p<0.05). Transfusion of packed cells was 6.03±1.50 and 6.03±1.22 units in case and control groups respectively. Transfusion of fresh frozen plasma (FFP) was 2.50±1.36 and 3.03±0.96 units in case and control groups respectively (p=0.09). Transfusion of platelets was 0.40±0.20 1.33±0.31 units in case and control groups respectively (p=0.01). Three patients (10%) in the case group and 4 patients (13.3%) in the control group were expired (p=0.50). Tranexamic acid is safe and effective in reducing platelet transfusion rate in patients with trauma-related significant hemorrhage. However, transfusion need and mortality would not reduce by its use in trauma patients.

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The Effectiveness of Online Course Intervention to Improve Knowledge of Antimicrobial Resistance among Dental Students, in Comparison to Reference Group Using a Randomized Controlled Trial

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2019.723 ◽

2019 ◽

Vol 7 (17) ◽

pp. 2917-2923

Author(s):

Khalid T. Aboalshamat ◽

Assim M. Banjar ◽

Mahmoud I. Al-Jaber ◽

Noor M. Turkistani ◽

Mohammed T. Al-Amoudi

Keyword(s):

Randomised Controlled Trial ◽

Controlled Trial ◽

Dental Students ◽

Online Course ◽

Control Group ◽

Study Group ◽

Control Groups ◽

Significant Difference ◽

Randomised Controlled ◽

And Control

AIM: This study aimed to assess the effectiveness of a recognised antimicrobial resistance (AMR) online module on knowledge and perception among dental students, using a randomised controlled trial study design. METHODS: Dental students (n = 64, aged 21-25 years) in clinical years agreed to participate in this triple-blinded, parallel, randomised controlled trial. There were 34 students in the study group and 30 students in the control group. The study group participated in an online course covering information about AMR, while students in the control group received another online course about microorganisms in dentistry. Both groups were assessed three times using online questionnaires: before the intervention (T1), after the intervention (T2), and two months later (T3). Each one of T1, T2 and T3 had 22 questions. The questions were repeated each time in T1, T2, and T3 asking about AMR but with different question format, to avoid the possibility of students to memorise the answers. RESULTS: The mean (m) of correct answers for all students on T1 was 12.56, with standard deviation (SD) of 3.2. On T2, m = 14.03 and SD = 3.85, and on T3, m = 14.36 and SD = 3.71. Scores ranged from 0 to 22. The participants in the study and control groups showed significant score improvements from T1 to T2, immediately after the intervention, but there was no significant difference between T2 and T3. The study group students’ scores did not improve significantly from T1 to T3, in contrast to the control group students’ scores. More importantly, there was no significant difference in improvement from T1 to T2 when comparing the study and control groups. CONCLUSION: Online courses might not be reliable learning methods for ensuring the optimal levels of AMR knowledge that are needed by dental practitioners.

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Comparison of the upper respiratory tract width at the level of the adenoid in patients with normal and abnormal breathing route

Forum Ortodontyczne ◽

10.5604/01.3001.0012.2030 ◽

2018 ◽

Vol 14 (2) ◽

pp. 13-26

Author(s):

Anna Duda ◽

Wojciech Stós

Keyword(s):

Respiratory Tract ◽

Control Group ◽

Study Group ◽

Upper Respiratory Tract ◽

Control Groups ◽

Limit Values ◽

Significant Difference ◽

Abnormal Breathing ◽

Upper Respiratory ◽

And Control

This study assesses the upper respiratory tract width at the level of the adenoid in patients with a normal (nasal) and abnormal (oral or mixed) breathing route. Aim. To compare the upper respiratory tract width in the study group (abnormal breathing route) and control group (normal breathing route) and to determine the cut-off point and mean limit values in order to conduct a differential diagnosis between a habitual and constitutional breathing route. Material and methods. The study included 221 patients treated at the Aquadent-Ortoestetyka Clinic in Kielce. Based on the medical history taken, clinical examination and subjective evaluation of the upper respiratory tract width according to Holmberg 112 patients were enrolled into the study group and 109 patients into the control group. The upper respiratory tract width was measured with two different linear methods: a modified method by Holmberg. and Linder-Aronson, and the Linder-Aronson and Henricson method (AD1-PNS, AD2-PNS). Results. In the study group the mean value of the Holmberg measurement is 4.25 mm, and in the control group – 14.1 mm. Mean values of AD1- PNS and AD2-PNS measurements in the study group are 8.1 mm and 9.5 mm, respectively, and they can be regarded as mean limit values. The 6 mm Holmberg measurement is the cut-off value between the study and control groups, and it should be monitored. In relation to the Holmberg measurement a difference between the study and control groups is 9.85 mm. Regarding AD1-PNS and AD2-PNS measurements a difference between the study and control groups is 11.4 mm and 10.0 mm, respectively. Conclusions. The upper respiratory tract width at the level of the adenoid shows a statistically significant difference between the study and control groups. It may indicate significant narrowing of the upper respiratory tract at the level of the adenoid in the study group or a different type of morphology of the facial skeleton. Limit values obtained in the study allow differentiation of a habitual and constitutional breathing route. (Duda A, Stós W. Comparison of the upper respiratory tract width at the level of the adenoid in patients with normal and abnormal breathing route. Orthod Forum 2018; 14: 106-18).

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Does tranexamic acid have role in controlling intraoperative blood loss in tonsillectomy?

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20202776 ◽

2020 ◽

Vol 6 (7) ◽

pp. 1253

Author(s):

Heempali Das Dutta ◽

Pabina Rayamajhi ◽

Nazeef Ibrahim

Keyword(s):

Blood Loss ◽

Tranexamic Acid ◽

Postoperative Bleeding ◽

University Teaching ◽

Control Group ◽

Study Group ◽

Intraoperative Blood Loss ◽

Intraoperative Bleeding ◽

The Difference ◽

And Control

Background: The study was done with the objective to assess the effect of tranexamic acid in controlling intraoperative bleeding in tonsillectomy.Methods: Retrospective study was conducted in the Department of ENT and HNS, Tribhuvan University Teaching Hospital, Kathmandu, Nepal from August 2016 to July 2017. Patients more than 15 years who underwent bilateral tonsillectomy were included in the study. Whereas patients who underwent unilateral tonsillectomy and patients who had hypersensitivity to tranexamic acid were excluded from the study. The patients who received tranexamic acid during surgery were taken as study group whereas the patients who didn’t receive tranexamic acid were taken as control. The amount of the intraoperative blood loss, i.e. mean and the frequency of early post-operative bleeding were evaluated. Results: A total of 48 patients who fulfilled the inclusion criteria were evaluated. Among whom, 24 patients who received tranexamic acid during tonsillectomy were taken as study group and other 24 patients who did not received tranexamic acid were taken as control. The mean blood loss in study and control group were 92.85 ml and 91.40 ml respectively and the difference was statistically not significant (p=0.785). There were no cases of early postoperative bleeding recorded in either group within the first 24 hours of surgery.Conclusions: There is no significant role of tranexamic acid in controlling intraoperative bleeding in tonsillectomy.

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