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The influence of prophylactic tranexamic acid on thromboelastography during cesarean delivery: A randomized, double-blind, placebo-controlled trial
Abstract Number: T-36
Abstract Type: Original Research
Postpartum hemorrhage (PPH) remains a leading cause of maternal morbidity and mortality worldwide (1). Reduction in blood loss and progression to PPH has been demonstrated with the antifibrinolytic agent tranexamic acid (TXA) 1g IV (2), but the underlying hemostatic changes in pregnancy have not been clearly delineated. Point-of-care devices such as thromboelastography (TEG®) can reveal coagulopathy and guide transfusion during PPH. TEG® split point (SP) and maximum amplitude (MA) reflect fibrin formation and fibrin-based clot strength, respectively, and have been correlated with blood loss during cesarean delivery (CD) (3). We hypothesized that TXA treatment would be detectable by TEG® SP or MA during CD.
ASA I or II patients undergoing elective CD with neuraxial anesthesia were randomized to receive TXA 1 g IV or placebo immediately prior to surgery. Maternal hemoglobin, platelet count, prothrombin time, activated partial thromboplastin time, fibrinogen, and global hemostatic profile by TEG® were measured at three times: one hour prior to surgery and before study dose administration (baseline), one hour after drug infusion, and two hours postpartum.
Twenty (TXA, n = 13; placebo, n = 7) of 200 patients have been recruited. Demographic and baseline laboratory values did not differ significantly between groups. TEG® parameters in both groups indicate hypercoagulable changes one hour post-infusion (Table), however, the magnitude of TEG® parameter changes between baseline and both subsequent times was not different between groups. There were no differences in hemoglobin change, secondary uterotonic requirement, or vasopressor requirement between groups.
Our preliminary findings show no global hemostatic TEG® changes in patients treated with a single IV dose of TXA 1g prior to CD. Evaluation with alternate TEG® assays, such as functional fibrinogen MA (4), or higher TXA doses may be necessary to indicate a difference in this patient population.
1. Collis RE and Collins PW. Anaesthesia 2015
2. Gungorduk K et al. Am J Perinatology 2011
3. Butwick AJ et al. Anesth Analg 2011
4. Solomon C et al. Anesth Analg 2012