Obstetrics
Postpartum haemorrhage related early increase in D-dimers is inhibited by tranexamic acid: haemostasis parameters of a randomized controlled open labelled trial

https://doi.org/10.1093/bja/aew021
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Abstract

Background

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.

Methods

Women with PPH >800 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.

Results

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.

Conclusions

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.

Clinical trial registration

ISRCTN09968140.

fibrinogen
fibrinolysis
postpartum haemorrhage
tranexamic acid

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