When Are Pregnant Patients Receiving Tranexamic Acid during Delivery Hospitalization in the United States?

IF 1.5 4区医学 Q3 OBSTETRICS & GYNECOLOGY American journal of perinatology Pub Date : 2025-02-01 Epub Date: 2024-06-26 DOI:10.1055/a-2353-0832

Julia Whitley, Seyedeh A Miran, Phillip Ma, George Saade, Ian Roberts, Homa K Ahmadzia

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Abstract

Objective: The World Health Organization recommends tranexamic acid (TXA) in the management of postpartum hemorrhage (PPH). However, the role of TXA in PPH prevention and the optimal timing of TXA administration remain unknown. Our objective was to describe the timing of TXA administration, differences in timing of TXA administration by mode of delivery, and current trends in TXA administration in the United States.

Study design: We conducted a descriptive study of trends in TXA administration using the Cerner Real-World Database. We identified 1,544,712 deliveries occurring at greater than 24 weeks' gestation from January 1, 2016, to February 21, 2023. Demographic data were collected including gestational age, mode of delivery, and comorbidities. The timing of TXA administration and differences in TXA timing by mode of delivery were also collected.

Results: In our cohort, 21,433 patients (1.39%) received TXA. The majority of patients who received TXA were between ages 25 and 34 years old (55.3%), White (60.7%), and delivered between 37 and 41^6/7 weeks (81.4%). The TXA group had a higher prevalence of medical comorbidities including obesity (32.9 vs. 19.0%, p < 0.00001), preeclampsia (19.6 vs. 6.81%, p < 0.00001), and pregestational diabetes (3.27 vs. 1.36%, p < 0.00001). Among women who received TXA, 15.4% received it within 3 hours before delivery. Among patients who received TXA after delivery, 23.6% received TXA within 3 hours after delivery, whereas 35.7% received TXA between 10 and 24 hours after delivery. A total of 80.4% of patients who received TXA before delivery had a cesarean delivery.

Conclusion: While TXA is most commonly administered after delivery, many patients are receiving TXA prior to delivery in the United States without clear evidence to guide the timing of administration. A randomized trial is urgently needed to determine the safety and efficacy of TXA when administered prior to delivery.

Key points: · TXA is used in the treatment of PPH.. · The role of TXA in prevention of PPH is unclear.. · Fewer than 2% of patients in the United States receive TXA at delivery.. · TXA administration before delivery in the United States is rising..

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在美国，孕妇何时在分娩住院期间接受氨甲环酸治疗？

目的：世界卫生组织推荐使用氨甲环酸（TXA）治疗产后出血（PPH）。然而，TXA 在预防 PPH 中的作用以及 TXA 的最佳用药时机仍是未知数。我们的目标是描述 TXA 的给药时机、不同分娩方式下 TXA 给药时机的差异以及美国 TXA 给药的当前趋势：我们使用 Cerner Real-World DatabaseTM 对 TXA 给药趋势进行了描述性研究。我们对 2016 年 1 月 1 日至 2023 年 2 月 21 日期间妊娠超过 24 周的 1,544,712 例分娩进行了鉴定。我们收集了包括胎龄、分娩方式和并发症在内的人口统计学数据。此外，还收集了使用 TXA 的时间以及不同分娩方式 TXA 使用时间的差异：在我们的队列中，有 21,433 名患者（1.4%）接受了促肾上腺皮质激素治疗。大多数接受 TXA 的患者年龄在 25 至 34 岁之间（55.3%），白人（60.7%），分娩时间在 37 周至 41 周零 6 天之间（81.4%）。TXA组产妇合并肥胖等内科疾病的比例更高（32.9%对19.0%，p）：虽然TXA最常在产后使用，但在美国，许多患者在产前接受TXA，但没有明确的证据来指导用药时机。目前急需进行一项随机试验，以确定在分娩前使用 TXA 的安全性和有效性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

American journal of perinatology 医学-妇产科学

CiteScore

5.90

自引率

0.00%

发文量

302

审稿时长

4-8 weeks

期刊介绍： The American Journal of Perinatology is an international, peer-reviewed, and indexed journal publishing 14 issues a year dealing with original research and topical reviews. It is the definitive forum for specialists in obstetrics, neonatology, perinatology, and maternal/fetal medicine, with emphasis on bridging the different fields. The focus is primarily on clinical and translational research, clinical and technical advances in diagnosis, monitoring, and treatment as well as evidence-based reviews. Topics of interest include epidemiology, diagnosis, prevention, and management of maternal, fetal, and neonatal diseases. Manuscripts on new technology, NICU set-ups, and nursing topics are published to provide a broad survey of important issues in this field. All articles undergo rigorous peer review, with web-based submission, expedited turn-around, and availability of electronic publication. The American Journal of Perinatology is accompanied by AJP Reports - an Open Access journal for case reports in neonatology and maternal/fetal medicine.