Recent trends in tranexamic acid use during postpartum hemorrhage in the United States.
Recent trends in tranexamic acid use during postpartum hemorrhage in the United States.
复制标题
美国产后出血期间氨甲环酸使用的最新趋势。
DOI：
10.1007/s11239-023-02785-y
复制
发表时间：
2023
影响因子：
4
通讯作者：
Ahmadzia,HomaK
中科院分区：
文献类型：
--
作者：
Litman,EthanA;Ma,Phillip;Miran,SeyedehA;Nelson,StuartJ;Ahmadzia,HomaK
产后出血（PPH）是孕产妇死亡的第二大原因，约占2017年至2019年美国所有妊娠相关死亡的14%。几个大型多中心研究表明，使用氨甲环酸（TXA）可以降低PPH率。关于产科患者中TXA使用的流行率的数据很少。方法：在2015年1月1日至2021年6月30日期间，我们通过使用Cerner真实世界数据库™的国际疾病和相关健康问题统计分类第十版代码，确定了超过120万名患有或不患有PPH的美国孕妇。从电子病历中提取TXA的使用情况和患者特征。结果：在分娩期间，大约1%的时间使用了TXA（12,394 / 1,262,574）。孕妇在分娩时接受和未接受TXA的人口统计学特征相似。剖宫产（4,356 / 12,394）、足月分娩（10,199 / 12,394）和有合并症的孕妇在住院分娩期间更容易接受TXA。TXA的使用主要集中在亚利桑那州、科罗拉多州、爱达荷州、新墨西哥州、内华达州、犹他州和怀俄明州。在研究期间，PPH患者和非PPH患者的TXA使用量均有所增加。结论：数据表明，2017年后，TXA的使用迅速增加，而妊娠总数保持相对稳定。观察到的TXA使用的增加可能反映了随着对PPH预防设置中使用TXA的支持增加而改变的实践模式。
Introduction: Postpartum hemorrhage (PPH) was the second leading cause of maternal death, accounting for approximately 14% of all pregnancy-related deaths between 2017 and 2019 in the United States. Several large multi-center studies have demonstrated decreased PPH rates with the use of tranexamic acid (TXA). Little data exists regarding the prevalence of TXA use in obstetric patients.Methods: We identified over 1.2 million US pregnancies between January 1, 2015 and June 30, 2021, with and without PPH byInternational Statistical Classification of Disease and Related Health Problems, Tenth Revision codesusing Cerner Real-World Database™. TXA use and patient characteristics were abstracted from the electronic medical record.Results: During delivery, TXA was used approximately 1% of the time (12,394 / 1,262,574). Pregnant patients who did and did not receive TXA during delivery had similar demographic characteristics. Pregnant patients who underwent cesarean delivery (4,356 / 12,394), had a term delivery (10,199 / 12,394), and had comorbid conditions were more likely to receive TXA during hospitalization for delivery. The majority of TXA was use was concentrated in Arizona, Colorado, Idaho, New Mexico, Nevada, Utah, and Wyoming. During the study period the use of TXA increased in both patients with PPH and those without.Conclusion:The data illustrate a rapid increase in the use of TXA after 2017 while the total number of pregnancies remained relatively constant. The observed increase in TXA use may reflect changing practicing patterns as the support for use of TXA in the setting of PPH prophylaxis increases.