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Thromb Haemost 2022; 122(11): 1869-1878
DOI: 10.1055/s-0042-1755379
Coagulation and Fibrinolysis

Hemostatic Effects of Tranexamic Acid in Cesarean Delivery: An Ancillary Study of the TRAAP2 Study

Stéphanie Roullet
1   Pôle d'Anesthésie-Réanimation, CHU Bordeaux, Bordeaux, France
2   INSERM, Biologie des Maladies Cardiovasculaires, University of Bordeaux, U1034, Pessac, France
,
Timothée Rivoire
1   Pôle d'Anesthésie-Réanimation, CHU Bordeaux, Bordeaux, France
,
Clémence Houssin
3   Département de Gynécologie et Obstétrique, CHU Bordeaux, Bordeaux, France
,
Sylvie Labrouche
2   INSERM, Biologie des Maladies Cardiovasculaires, University of Bordeaux, U1034, Pessac, France
4   Laboratoire d'hématologie, CHU Bordeaux, Bordeaux, France
,
Sandrine Paquin
1   Pôle d'Anesthésie-Réanimation, CHU Bordeaux, Bordeaux, France
,
Karine Nouette-Gaulain
1   Pôle d'Anesthésie-Réanimation, CHU Bordeaux, Bordeaux, France
5   INSERM, Maladies Rares: Génétique et Métabolisme, University of Bordeaux, Bordeaux, France
,
Catherine Deneux-Tharaux
6   INSERM, Perinatal Obstetrical and Pediatric Epidemiology Research Team (EPOPé), Centre for Research on Epidemiology and Statistics (CRESS), Paris University, Paris, France
,
Jean Amiral
7   SH-Consulting, Andrésy, France
,
Chloé James
2   INSERM, Biologie des Maladies Cardiovasculaires, University of Bordeaux, U1034, Pessac, France
4   Laboratoire d'hématologie, CHU Bordeaux, Bordeaux, France
,
Loïc Sentilhes
3   Département de Gynécologie et Obstétrique, CHU Bordeaux, Bordeaux, France
› Author Affiliations Funding This study was funded by the Bordeaux Association for Training and Research in Obstetrics and Gynecology (ABFREGO) and by the Anesthesiologist Association in Vascular and Transplantation Surgery (AARCVT). The funding sources had no role in the design of this study, the collection, analysis or interpretation of data, the writing of this report, or in the decision to submit this article for publication.
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Abstract

Background Fibrinolysis activation during delivery contributes to postpartum hemorrhage (PPH). Clot lysis time studied with the global fibrinolytic capacity device (GFC/LT) is a functional test which rapidly assesses fibrinolytic profile. Tranexamic acid (TXA) is an efficient antifibrinolytic therapy.

Methods We prospectively studied fibrinolysis and coagulation in 33 women included in the TRAAP2 trial, which aimed to assess the impact of TXA in preventing PPH following a cesarean delivery. TXA or placebo was randomly administered after childbirth as part of the TRAAP2 trial's protocol. Fibrinolytic (GFC/LT, plasma concentration of fibrinolysis activators and inhibitors) and hemostatic parameters were assayed at three sample times (TREF [T-reference] after anesthesia, T15 and T120minutes after TXA, or placebo administration).

Results All cesarean deliveries were elective. In the placebo group, the clot lysis time assessed with GFC/LT significantly decreased between TREF and T120, indicating an activated fibrinolysis (44 [interquartile range, IQR: 40–48] vs. 34 [IQR: 30–36] minutes, p<0.001). In both TXA and placebo groups, significant fluctuations of the plasmatic concentrations of fibrinolytic mediators were noticed over time, suggesting fibrinolysis activation. Clot lysis time measured by GFC/LT was significantly increased in women of the TXA group as compared with those in the placebo group at T15 (120 [120–120] vs. 36 [34–41] minutes, p<0.001) and T120minutes (113 [99–120] vs. 34 [30–36] minutes, p<0.001) after drug administration, indicating a decreased in fibrinolysis in those women.

Conclusion GFC/LT evidenced fibrinolysis activation during cesarean delivery, linked to a decrease in fibrinolytic inhibitors. GFC/LT revealed a significant antifibrinolytic effect of TXA compared with placebo.

Keywords

cesarean delivery - fibrinolysis - global fibrinolytic capacity - postpartum hemorrhage - tranexamic acid

Author Contributions

S.R. designed the study, collected data, analyzed data, and wrote the manuscript. T.R. collected data, analyzed data, and wrote the manuscript. C.H. and S.P. collected data. S.L. analyzed data. K.N.-G. and C.D.T. provided important intellectual input. J.A. collected and analyzed data. C.J. contributed to the study design. L.S. designed the study and wrote the manuscript. All authors reviewed and edited the manuscript and approved the final version.




Publication History

Received: 27 December 2021

Accepted: 25 June 2022

Article published online:
08 September 2022

© 2022. Thieme. All rights reserved.

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