Postpartum haemorrhage related early increase in D-dimers is inhibited by tranexamic acid: haemostasis parameters of a randomized controlled open labelled trial
| Autor: | Jeanpierre E, Alain Duhamel, Antoine Rauch, Sophie Susen, A. Prado-Dupont, C Huissoud, G. Debize, Ahmed Elkalioubie, A.S. Ducloy-Bouthors, D DeProst, Eric Kipnis, A Tournoys, E Peynaud-Debayle |
|---|---|
| Rok vydání: | 2016 |
| Předmět: |
medicine.medical_specialty
medicine.medical_treatment Urology 030204 cardiovascular system & hematology Fibrinogen law.invention Fibrin Fibrinogen Degradation Products 03 medical and health sciences 0302 clinical medicine Randomized controlled trial law Pregnancy Antifibrinolytic agent Fibrinolysis medicine Humans Single-Blind Method 030212 general & internal medicine Hemostatic function Blood Specimen Collection Hemostasis business.industry Postpartum Hemorrhage Postpartum haemorrhage Antifibrinolytic Agents Blood Coagulation Factors Anesthesiology and Pain Medicine Tranexamic Acid Anesthesia Female business Tranexamic acid medicine.drug |
| Zdroj: | British journal of anaesthesia. 116(5) |
| ISSN: | 1471-6771 |
| Popis: | Beneficial effects of tranexamic acid (TA) have been established in surgery and trauma. In ongoing postpartum haemorrhage (PPH), a moderate reduction of blood loss was observed in a previously published randomized controlled trial. Analysis of haemostasis parameters obtained from samples collected as part of this study are presented.Women with PPH800 ml after vaginal delivery were assigned to receive either TA (4 g over 1 h, then 1 g per h over six h) (TA) or not (H). A non-haemorrhagic group (NH),800 ml blood loss, was included as postpartum reference. At four time-points (enrolment, +30 min, +2 h, +6 h), haemostasis was assessed. Haemostasis assays were performed blinded to group allocation. Data were expressed as median [interquartiles] and compared with non-parametric tests.In H compared with NH group, D-dimers increase (3730 ng ml(-1) [2468-8493] vs 2649 [2667-4375]; P=0.0001) and fibrinogen and factor II decrease were observed at enrolment and became maximal 2 h later. When comparing TA to H patients, the increase in Plasmin-Antiplasmin-complexes at +30 min (486 ng ml(-1) [340-1116] vs 674 [548-1640]; P=0.03) and D-dimers at +2 h (3888 ng ml(-1) [2688-6172] vs 7495 [4400-15772]; P=0.0001) was blunted. TA had no effect on fibrinogen decrease.This study provides biological evidence of an early increase in D-dimers and plasmin-antiplasmin complexes associated with active post-partum haemorrhage and its attenuation by the early use of a clinically effective high dose of TA, opening the perspective of dose ranging studies to determinate the optimal dose and timing in this setting.ISRCTN09968140. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
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