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Thromb Haemost 1993; 70(02): 238-240
DOI: 10.1055/s-0038-1649475
Original Articles
Clinical Studies
Schattauer GmbH Stuttgart

Treatment with Tranexamic Acid during Pregnancy, and the Risk of Thrombo-Embolic Complications

Claes Lindoff
1   The Departments of Obstetrics and Gynaecology, University of Lund, University Hospital, Lund
,
Göran Rybo
2   The University of Gothenburg, Eastern Hospital, Gothenburg, Sweden
,
Birger Åstedt
1   The Departments of Obstetrics and Gynaecology, University of Lund, University Hospital, Lund
› Author Affiliations
Further Information

Publication History

Received 11 September 1991

Accepted after revision 05 March 1993

Publication Date:
04 July 2018 (online)

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Summary

Tranexamic acid (AMCA) is an inhibitor of fibrinolysis used to treat fibrinolytic bleeding (e.g., menorrhagia and gastro-intestinal haemorrhage), and to prevent bleeding at surgery, in cases of abruptio placentae and general haemorrhage. As AMCA stabilises preformed clots and prolongs their dissolution, it has been debated whether treatment with AMCA might predispose to thrombosis by depressing the fibrinolytic system. Pregnant women constitute a group with low fibrinolytic capacity and an increased frequency of thrombosis further increased after Caesarean section, and are thus more likely to be susceptible to antifibrinolytic therapy. We therefore carried out a retrospective analysis of the case records of 2,102 patients with various bleeding disorders during pregnancy. Of the 256 patients treated with AMCA (mean duration of treatment, 46 days), 169 were delivered by Caesarean section. Of the remaining 1,846 patients (i.e., controls), 443 were delivered by Caesarean section. The relationship between the use of AMCA and the occurrence of thrombo-embolism was calculated with 95% confidence limits.

Of the AMCA treated group (n = 256), two patients – one of whom belonged to the Caesarean section subgroup (n = 168) – had pulmonary embolism. Of the controls (n = 1,846), three patients had deep vein thrombosis and one had pulmonary embolism, all four cases belonging to the Caesarean section subgroup (n = 443). Thus, the findings in this high risk group of women with complicated pregnancies, frequently entailing delivery by Caesarean section, provided no evidence of any thrombogenic effect of AMCA.

 

  • References

  • 1 Nilsson L, Rybo G. Treatment of menorrhagia with an antifibrinolytic agent tranexamic acid (AMCA). A double-blind investigation. Acta Obstet Gynecol Scand 1967; 46: 572-580
    CrossrefPubMedGoogle Scholar
  • 2 Callender ST, Warner GT, Cope E. Treatment of menorrhagia with tranexamic acid. A double-blind trial. Br Med J 1970; 04: 214-216
    CrossrefPubMedGoogle Scholar
  • 3 Nilsson L, Rybo G. Treatment of menorrhagia. Am J Obstet 1971; 110: 713-720
    CrossrefPubMedGoogle Scholar
  • 4 Cormack F, Chakrabarti RR, Jouhar AJ, Fearnley GR. Tranexamic acid in upper gastrointestinal haemorrhage. Lancet 1973; i: 1207-1208
    PubMedGoogle Scholar
  • 5 Barer D, Ogilvie A, Coggon D, Henry D, Atkinson M, Langman MJS. Cimetidine and tranexamic acid in the treatment of acute upper gastrointestinal bleeding. N Engl J Med 1983; 308: 157l-1575
    PubMedGoogle Scholar
  • 6 Stael von Holstein C, Eriksson SBS, Källen R. Tranexamic acid as an aid to reducing blood transfusion requirements in gastric and duodenal bleeding. Br Med J 1987; 294: 7-10
    CrossrefPubMedGoogle Scholar
  • 7 Petrusson B. A double-blind study to evaluate the effect on epistaxis with oral administration of the antifibrinolytic drug tranexamic acid (Cyklokapron®). Acta Oto-Laryngol 1974; (Suppl. 317) 57-61
    PubMedGoogle Scholar
  • 8 Rybo G, Westerberg H. The effect of tranexamic acid (AMCA) on, postoperative bleeding after conization. Acta Obstet Gynecol Scand 1972; 5l: 347-350
    PubMedGoogle Scholar
  • 9 Lundvall F, Nielsen NC. The hemostatic effect of tranexamic acid in conisatio colli uteri. Acta Obstet Gynecol Scand 1984; 63: 81-84
    PubMedGoogle Scholar
  • 10 Grundsell H, Larsson G, Békássy L. Use of an antifibrinolytic agent (tranexamic acid) and lateral sutures with laser conization of the cervix. Obstet Gynecol 1984; 64: 573-576
    PubMedGoogle Scholar
  • 11 Hedlund PO. Antifibrinolytic therapy with Cyklokapron in connection with prostatectomy. Scand J Urol Nephrol 1969; 3: 177-182
    CrossrefPubMedGoogle Scholar
  • 12 Miller RA, May MW, Hendry WF, Whitfield HN, Wickham JEA. The prevention of secondary haemorrhage after prostatectomy: the value of antifibrinolytic therapy. Br J Urol 1980; 52: 26-28
    CrossrefPubMedGoogle Scholar
  • 13 Åstedt B, Nilsson IM. Recurrent abruptio placentae treated with the fibrinolytic inhibitor tranexamic acid. Br Med J 1978; 1: 756-757
    PubMedGoogle Scholar
  • 14 Svanberg L, Åstedt B, Nilsson IM. Abruptio placentae – Treatment with the fibrinolytic inhibitor tranexamic acid. Acta Obstet Gynecol Scand 1980; 59: 127-130
    CrossrefPubMedGoogle Scholar
  • 15 Sheffer AL, Austen KF, Rosen FS. Tranexamic acid therapy in hereditary angioneurotic edema. N Engl J Med 1972; 287: 452-454
    CrossrefPubMedGoogle Scholar
  • 16 Åstedt B. Clinical pharmacology of tranexamic acid. Scand J Gastroenterol 1987; 22: 22-25
    PubMedGoogle Scholar
  • 17 Isacson S, Nilsson IM. Defective fibrinolysis in blood and vein walls in recurrent “idiopathic” venous thrombosis. Acta Chir Scand 1972; 138: 313-319
    PubMedGoogle Scholar
  • 18 Nilsson IM, Kullander S. Coagulation and fibrinolytic studies during pregnancy. Acta Obstet Gyn Scand 1967; 46: 273-285
    CrossrefPubMedGoogle Scholar
  • 19 Villasanta U. Thromboembolic desease in pregnancy. Am J Obstet Gynecol 1965; 93: 142-160
    CrossrefPubMedGoogle Scholar
  • 20 Bergqvist D, Bergqvist A, Hallböök T. Acute deep vein thrombosis after Caesarean section. Acta Obstet Gyn Scand 1979; 58: 473-476
    CrossrefPubMedGoogle Scholar
  • 21 Hellgren M. Thromboembolism and pregnancy. Studies on blood coagulation, fibrinolysis and treatment with heparin and antithrombin. Thesis, Stockholm 1981; 7-62
    PubMedGoogle Scholar
  • 22 Letsky V. Thromboembolism diseases in pregnancy. Am J Obstet Gynecol 1965; 93: 142-160
    CrossrefPubMedGoogle Scholar
  • 23 Rutherford SE. Thromboembolic disease in pregnancy. Clin Perinatol 1986; 13: 719-739
    CrossrefPubMedGoogle Scholar
  • 24 Mogensen K, Skibsted L, Wadt J, Nissen F. Thrombectomy of acute iliofemoral venous thrombosis during pregnancy. Surg Gynecol Obstet 1989; 169: 50-54
    PubMedGoogle Scholar
  • 25 Weiner CP. Diagnosis and management of thromboembolic disease during pregnancy. Clin Obstet Gynecol 1985; 28: 107-118
    CrossrefPubMedGoogle Scholar
  • 26 Bonnar J. Venous thromboembolism and pregnancy. Recent advances in obstetrics and gynecology. Churchill Livingstone, Edinburgh 1979; 173-192
    PubMedGoogle Scholar
  • 27 Endo Y, Nishimura S, Miura A. Deep-vein thrombosis induced by tranexamic acid in idiopathic thrombocytopenic purpura. JAMA 1988; 259: 3561-3562
    PubMedGoogle Scholar
  • 28 Awisati G, ten Cate JW, Büller HR, Mandelli F. Tranexamic acid for control of haemorrhage in acute promyelocytic leukaemia. Lancet 1989; 2: 122-124
    PubMedGoogle Scholar
  • 29 Åstedt B, Bekassy Z. Treatment with the fibrinolytic inhibitor tranexamic acid – risk for thrombosis?. Acta Obstet Gynecol Scand 1990; 69: 353-354
    CrossrefPubMedGoogle Scholar
  • 30 Nilsson IM, Ljungnér H, Tengborn L. Two different mechanisms in patients with venous thrombosis and defective fibrinolysis: Low concentration of plasminogen activator or increased concentration of plasminogen activator inhibitor. Br Med J 1985; 290: 1453-1456
    CrossrefPubMedGoogle Scholar
  • 31 Åstedt B, Liedholm P. Tranexamic acid and fibrinolytic activity of the vessel wall. Experientia 1974; 30: 776
    CrossrefPubMedGoogle Scholar
  • 32 Åstedt B, Liedholm P, Wingerup L. The effect of tranexamic acid on the fibrinolytic activity of vein walls. Ann Chir Gynaecol 1978; 67: 203-205
    PubMedGoogle Scholar
  • 33 Walzman M, Bonnar J. Effects of tranexamic acid on the coagulation and fibrinolytic systems in pregnancy complicated by placental bleeding. Arch Toxicol 1982; 5: 214-220
    PubMedGoogle Scholar