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Tranexamic Acid for the Prevention of Blood Loss after Cesarean Delivery

dc.rights.licenseopenen_US
dc.contributor.authorSENTILHES, Loic
dc.contributor.authorSENAT, Marie V.
dc.contributor.authorLE LOUS, Maela
dc.contributor.authorWINER, Norbert
dc.contributor.authorROZENBERG, Patrick
dc.contributor.authorKAYEM, Gilles
dc.contributor.authorVERSPYCK, Eric
dc.contributor.authorFUCHS, Florent
dc.contributor.authorAZRIA, Elie
dc.contributor.authorGALLOT, Denis
dc.contributor.authorKORB, Diane
dc.contributor.authorDESBRIERE, Raoul
dc.contributor.authorLE RAY, Camille
dc.contributor.authorCHAULEUR, Celine
dc.contributor.authorDE MARCILLAC, Fanny
dc.contributor.authorPERROTIN, Franck
dc.contributor.authorPARANT, Olivier
dc.contributor.authorSALOMON, Laurent J.
dc.contributor.authorGAUCHOTTE, Emilie
dc.contributor.authorBRETELLE, Florence
dc.contributor.authorSANANES, Nicolas
dc.contributor.authorBOHEC, Caroline
dc.contributor.authorMOTTET, Nicolas
dc.contributor.authorLEGENDRE, Guillaume
dc.contributor.authorLETOUZEY, Vincent
dc.contributor.authorHADDAD, Bassam
dc.contributor.authorVARDON, Delphine
dc.contributor.authorMADAR, Hugo
dc.contributor.authorMATTUIZZI, Aurelien
dc.contributor.authorDANIEL, Valerie
dc.contributor.authorREGUEME, Sophie
dc.contributor.authorROUSSILLON, Caroline
hal.structure.identifierBordeaux population health [BPH]
dc.contributor.authorBENARD, Antoine
hal.structure.identifierBordeaux population health [BPH]
dc.contributor.authorGEORGET, Aurore
dc.contributor.authorDARSONVAL, Astrid
dc.contributor.authorDENEUX-THARAUX, Catherine
dc.date.accessioned2021-06-30T09:48:22Z
dc.date.available2021-06-30T09:48:22Z
dc.date.issued2021-04-29
dc.identifier.issn0028-4793en_US
dc.identifier.urihttps://oskar-bordeaux.fr/handle/20.500.12278/94934
dc.description.abstractEnBACKGROUND: Prophylactic administration of tranexamic acid has been associated with reduced postpartum blood loss after cesarean delivery in several small trials, but evidence of its benefit in this clinical context remains inconclusive. METHODS: In a multicenter, double-blind, randomized, controlled trial, we assigned women undergoing cesarean delivery before or during labor at 34 or more gestational weeks to receive an intravenously administered prophylactic uterotonic agent and either tranexamic acid (1 g) or placebo. The primary outcome was postpartum hemorrhage, defined as a calculated estimated blood loss greater than 1000 ml or receipt of a red-cell transfusion within 2 days after delivery. Secondary outcomes included gravimetrically estimated blood loss, provider-assessed clinically significant postpartum hemorrhage, use of additional uterotonic agents, and postpartum blood transfusion. RESULTS: Of the 4551 women who underwent randomization, 4431 underwent cesarean delivery, 4153 (93.7%) of whom had primary outcome data available. The primary outcome occurred in 556 of 2086 women (26.7%) in the tranexamic acid group and in 653 of 2067 (31.6%) in the placebo group (adjusted risk ratio, 0.84; 95% confidence interval [CI], 0.75 to 0.94; P = 0.003). There were no significant between-group differences in mean gravimetrically estimated blood loss or in the percentage of women with provider-assessed clinically significant postpartum hemorrhage, use of additional uterotonic agents, or postpartum blood transfusion. Thromboembolic events in the 3 months after delivery occurred in 0.4% of women (8 of 2049) who received tranexamic acid and in 0.1% of women (2 of 2056) who received placebo (adjusted risk ratio, 4.01; 95% CI, 0.85 to 18.92; P = 0.08). CONCLUSIONS: Among women who underwent cesarean delivery and received prophylactic uterotonic agents, tranexamic acid treatment resulted in a significantly lower incidence of calculated estimated blood loss greater than 1000 ml or red-cell transfusion by day 2 than placebo, but it did not result in a lower incidence of hemorrhage-related secondary clinical outcomes. (Funded by the French Ministry of Health; TRAAP2 ClinicalTrials.gov number, NCT03431805.).
dc.language.isoENen_US
dc.title.enTranexamic Acid for the Prevention of Blood Loss after Cesarean Delivery
dc.typeArticle de revueen_US
dc.identifier.doi10.1056/NEJMoa2028788en_US
dc.subject.halSciences du Vivant [q-bio]/Santé publique et épidémiologieen_US
dc.identifier.pubmed33913639en_US
bordeaux.journalNew England Journal of Medicineen_US
bordeaux.page1623-1634en_US
bordeaux.volume384en_US
bordeaux.hal.laboratoriesBordeaux Population Health Research Center (BPH) - UMR 1219en_US
bordeaux.issue17en_US
bordeaux.institutionUniversité de Bordeauxen_US
bordeaux.institutionINSERMen_US
bordeaux.teamEMOSen_US
bordeaux.teamPharmacoEpi-Drugsen_US
bordeaux.peerReviewedouien_US
bordeaux.inpressnonen_US
hal.exportfalse
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