Summary
Tranexamic acid (AMCA) is an inhibitor of fibrinolysis used to treat fibrinolytic
bleeding (e.g., menorrhagia and gastro-intestinal haemorrhage), and to prevent bleeding
at surgery, in cases of abruptio placentae and general haemorrhage. As AMCA stabilises
preformed clots and prolongs their dissolution, it has been debated whether treatment
with AMCA might predispose to thrombosis by depressing the fibrinolytic system. Pregnant
women constitute a group with low fibrinolytic capacity and an increased frequency
of thrombosis further increased after Caesarean section, and are thus more likely
to be susceptible to antifibrinolytic therapy. We therefore carried out a retrospective
analysis of the case records of 2,102 patients with various bleeding disorders during
pregnancy. Of the 256 patients treated with AMCA (mean duration of treatment, 46 days),
169 were delivered by Caesarean section. Of the remaining 1,846 patients (i.e., controls),
443 were delivered by Caesarean section. The relationship between the use of AMCA
and the occurrence of thrombo-embolism was calculated with 95% confidence limits.
Of the AMCA treated group (n = 256), two patients – one of whom belonged to the Caesarean section subgroup (n = 168) – had pulmonary embolism. Of the controls (n = 1,846), three patients had deep vein thrombosis and one had pulmonary embolism,
all four cases belonging to the Caesarean section subgroup (n = 443). Thus, the findings in this high risk group of women with complicated pregnancies,
frequently entailing delivery by Caesarean section, provided no evidence of any thrombogenic
effect of AMCA.
