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The use of tranexamic acid in postpartum haemorrhage (PPH) - a UK-Wide survey.
Abstract Number: F3B-225
Abstract Type: Original Research
The WOMAN trial concluded that the early use of tranexamic acid (TXA) in PPH reduces mortality due to bleeding but also does not increase the risk of adverse effects (1). While some clinicians have viewed this study as a "game changer", others remain cautious as to the true impact of these results. We conducted this survey to gain an impression of the influence of the WOMAN trial on the use of TXA within obstetric units in the UK.
We conducted an OAA approved, national survey sent electronically to 164 obstetric anaesthesia departmental leads in the UK. We aimed to examine how clinicians’ practices have changed as a result of the WOMAN trial and if local guidelines for the management of PPH have been updated. Respondents were asked if existing concerns remained regarding TXA use and if any adverse events were thought to be attributed to this drug.
70 responses were received (43% response rate). 74% of units stated they have increased TXA use following the publication of the WOMAN trial with some noting a decline in the use of blood products and that TXA may have played a role in this trend. 73% report existing departmental guidelines describing TXA use in PPH prior to the trial and, of these, 53% have subsequently been updated. 2% have developed new guidelines since the study. Of the remaining 27% without departmental guidelines, a majority (63%) intend to write new recommendations. 16% of respondents expressed concerns regarding the safety of TXA, in particular the perceived risk of thromboembolic complications. 7% reported adverse events associated with TXA including hypotension (6%) and seizures (1%).
The survey results indicate an increase in TXA use in PPH management following the publication of the WOMAN trial. Many departments have either updated existing guidelines or developed new guidelines incorporating the use of TXA. Although the study design lends itself to criticism for having an unclear overall mortality benefit, the increase uptake in the use of TXA may be a result of both a reported decrease in deaths due to bleeding as well as a lack of adverse events. Comments from the survey reflect these considerations; while many departments reserve TXA for ongoing, active bleeding, some smaller, isolated units give it more liberally for PPH prophylaxis. Respondents do, however, advise caution in neglecting other measures to stop bleeding or administering TXA late once clotting factors have been consumed. Despite a NNT of 250, TXA is cheap, easy to administer and safe; the increase in its use reflects a national growing confidence that TXA may tip the balance towards a more favourable outcome in PPH.
1. WOMAN Trial Collaborators. 2017. Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial. Lancet. 389(10084):2105–2116