|
Author |
Alexandra Scott |
Date |
2020-02-23 |
|
Reviewer |
Dr Roxane Beaumont-Boileau |
Edited |
A primary care ambulance resource in a rural BC community responds to a 35-year-old female in active labor. The imminent delivery progresses without complications and the neonate is delivered requiring no resuscitative efforts. The transport time to the nearest rural medical facility is 30 minutes by road. Whilst en route and following placental delivery, the mother begins hemorrhaging vaginally a moderate amount. The patient is tachycardic at 120 with a blood pressure of 85/60. Vascular access is established, and normal saline is being administered. Could TXA be a consideration for this particular patient?
“Can tranexamic acid (TXA) improve the prognosis of patients experiencing postpartum hemorrhage in a prehospital setting?”
|
Population |
Patients experiencing prehospital postpartum hemorrhage |
|
Intervention |
TXA administration |
|
Comparison |
No TXA administration |
|
Outcome |
Improved patient prognosis |
PubMed: ("postpartum hemorrhage" OR "postpartum haemorrhage") AND ("tranexamic acid" OR "TXA"), limited to publication dates 2011-2021 and “randomized controlled trial” was selected as search criteria.
JIBC Library: ("postpartum hemorrhage" OR "postpartum haemorrhage") AND ("tranexamic acid" OR "TXA"), limited to publication dates 2011-2021 and “scholarly (peer reviewed) journals” was selected as search criteria.
PubMed search yielded 23 results (2 relevant, 1 additional) on 2021-02-23. JIBC Library search yielded 475 results (1 relevant) on 2021-02-23.
All studies discussed are randomized controlled trials, contributing a high level of evidence to this topic. 200 pregnant women in Egypt undergoing a vaginal delivery were compared after being treated with either 60mg/kg IV TXA during labor or a placebo treatment.1 It was discovered that total blood loss during and after delivery was significantly less in women treated with TXA, thereby decreasing postpartum hemorrhage (defined here as >500 mL blood loss), and improving patient prognosis.1 Another study included 144 women in France experiencing postpartum hemorrhage (defined here as >800 mL blood loss) within 2 hours of vaginal delivery.2 These women received either IV TXA (4g over 1 hour, then infusion of 1g/hour over 6 hours) or no treatment.2 It was found that total blood loss was significantly decreased in the TXA-treated group, and bleeding ceased quicker than in the control group.2 The international WOMAN trial studied 20,060 women experiencing postpartum hemorrhage (defined here as >500 mL blood loss) following a vaginal birth or cesarian section.3 These women received either 1g IV TXA or a placebo treatment (with potential for subsequent treatments if bleeding continued.)3 It was found that death due to bleeding was significantly reduced by TXA, especially when TXA was given within 3 hours of delivery.3 There was no significant difference in risk of thrombotic events between treatment groups.3
These findings suggest that TXA could be used to reduce postpartum hemorrhage and improve patient prognosis, especially with early administration. If TXA was administered for prehospital childbirth, this would be the earliest possible administration of the medication. There is also evidence to suggest that the chances of negative side-effects from TXA are low, though none of these trials were conducted in a prehospital setting. Therefore, one must assume and extrapolate that these results would be reproducible in a prehospital setting, which may not be true. Overall, TXA has been shown in multiple studies to be a useful aid in the management of patients experiencing postpartum hemorrhage by reducing overall blood loss and mortality rate. Therefore, this medication could be considered for supplementing existing paramedic treatments for life-threatening vaginal hemorrhage in a prehospital setting. This use would be particularly beneficial in the context of rural paramedics faced with lengthy transport times to definitive care.