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Am J Perinatol
DOI: 10.1055/a-2353-0832
Original Article

When are pregnant patients receiving tranexamic acid during delivery hospitalization in the United States?

Julia Whitley 
1   Obstetrics and Gynecology, Washington University School of Medicine in Saint Louis, St Louis, United States (Ringgold ID: RIN12275)
,
Seyedeh Azadeh Miran
2   The George Washington University School of Medicine and Health Sciences, Washington, United States (Ringgold ID: RIN43989)
,
Phillip Ma
2   The George Washington University School of Medicine and Health Sciences, Washington, United States (Ringgold ID: RIN43989)
,
George Saade
3   OB-GYN, EVMS, Norfolk, United States (Ringgold ID: RIN6040)
,
Ian Roberts
4   Clinical Trials Unit, London School of Hygiene & Tropical Medicine, London, United Kingdom of Great Britain and Northern Ireland (Ringgold ID: RIN4906)
,
Homa Ahmadzia
5   Obstetrics and Gynecology, Inova Health System, Falls Church, United States (Ringgold ID: RIN3313)
› Author AffiliationsSupported by: National Heart, Lung, and Blood Institute K23HL141640
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Objective: The World Health Organization recommends tranexamic acid (TXA) in the management of postpartum hemorrhage (PPH). However, the role of TXA in PPH prevention and the optimal timing of TXA administration remain unknown. Our objective was to describe the timing of TXA administration, differences in timing of TXA administration by mode of delivery, and current trends in TXA administration in the U.S. Study Design: We conducted a descriptive study of trends in TXA administration using the Cerner Real-World DatabaseTM. We identified 1,544,712 deliveries occurring at greater than 24 weeks gestation from January 1, 2016 to February 21, 2023. Demographic data were collected including gestational age, mode of delivery, and co-morbidities. The timing of TXA administration and differences in TXA timing by mode of delivery were also collected. Results: In our cohort, 21,433 patients (1.4%) received TXA. The majority of patients who received TXA were between ages 25 and 34 years old (55.3%), White (60.7%), and delivered between 37 weeks and 41 weeks and 6 days (81.4%). The TXA group had a higher prevalence of medical co-morbidities including obesity (32.9% versus 19.0%, p<0.00001), pre-eclampsia (19.6% versus 6.81%, p<0.00001), and pre-gestational diabetes (3.27% versus 1.36%, p<0.00001). Among women who received TXA, 15.4% received it within 3 hours before delivery. Among patients who received TXA after delivery, 23.6% received TXA within 3 hours after delivery while 35.7% received TXA between 10 and 24 hours after delivery. 80.4% of patients who received TXA before delivery had a cesarean delivery. Conclusion: While TXA is most commonly administered after delivery, many patients are receiving TXA prior to delivery in the United States without clear evidence to guide the timing of administration. A randomized trial is urgently needed to determine the safety and efficacy of TXA when administered prior to delivery.



Publication History

Received: 18 April 2024

Accepted after revision: 20 June 2024

Accepted Manuscript online:
26 June 2024

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