Tranexamic Acid for Prevention and Treatment of Postpartum Hemorrhage: An Update on Management and Clinical Outcomes
Tranexamic Acid for Prevention and Treatment of Postpartum Hemorrhage: An Update on Management and Clinical Outcomes
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DOI：
10.1097/ogx.0000000000000597
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发表时间：
2018-10-01
影响因子：
6.2
通讯作者：
James, Andra H.
中科院分区：
文献类型：
--
作者：
Ahmadzia, Homa K.;Phillips, Jaclyn M.;James, Andra H.
产后出血（PPH）仍然是全球孕产妇死亡的主要原因，发生在阴道分娩和剖宫产。我们目睹了PPH的预防和治疗方面的进展。氨甲环酸（TXA）目的本文的目的是总结现有的关于在产科中使用TXA的建议，并回顾TXA使用后临床结局的当前数据。证据获取我们回顾了一些专业协会的指南，并进行了广泛的文献检索，回顾了该领域的相关和当前数据。结果结论在预防PPH中，阴道分娩和剖宫产前使用TXA可减少产后出血量，对于出血风险较高的患者应考虑使用。在PPH的治疗中，TXA应该早期开始，以从出血中获得最大的生存益处，如果在分娩后超过3小时给药，则不会提供额外的益处。总体而言，目前评估产科人群使用TXA风险的证据是令人放心的。目标受众妇产科医生，家庭医生。学习目标完成本活动后，学习者应该能够更好地：定义TXA的作用机制;评估TXA在预防和治疗PPH中的效用;定义围产期使用TXA的常用剂量;并评估使用TXA时的相关风险和可能的不良后果。
Importance Postpartum hemorrhage (PPH) remains a major cause of maternal mortality worldwide, occurring in both vaginal and cesarean deliveries. We have witnessed improvements in both prevention and treatment of PPH. Tranexamic acid (TXA) has been investigated as a potential adjunct therapy to uterotonics within this setting.Objective The aim of this article is to summarize existing recommendations on the use of TXA in obstetrics and review current data on clinical outcomes after TXA use.Evidence Acquisition We reviewed guidelines from a number of professional societies and performed an extensive literature search reviewing relevant and current data in this area.Results and Conclusions In the prevention of PPH, TXA use before both vaginal and cesarean deliveries reduces the amount of postpartum blood loss and should be considered in patients at higher risk for hemorrhage. In the treatment of PPH, TXA should be initiated early for maximal survival benefit from hemorrhage, and it provides no additional benefit if administered more than 3 hours from delivery. Overall, current evidence assessing the risks of TXA use in an obstetric population is reassuring.Target Audience Obstetricians and gynecologists, family physicians.Learning Objectives After completing this activity, the learner should be better able to: define the mechanism of action of TXA; evaluate the utility of TXA in prophylaxis and treatment of PPH; define common doses of TXA used in the peripartum period; and assess associated risk and possible adverse outcome when using TXA.