Hemostatic Effects of Tranexamic Acid in Cesarean Delivery: An Ancillary Study of the TRAAP2 Study

Stéphanie Roullet; Timothée Rivoire; Clémence Houssin; Sylvie Labrouche; Sandrine Paquin; Karine Nouette-Gaulain; Catherine Deneux-Tharaux; Jean Amiral; Chloé James; Loïc Sentilhes

doi:10.1055/s-0042-1755379

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2022; 122(11): 1869-1878
DOI: 10.1055/s-0042-1755379

Coagulation and Fibrinolysis

Hemostatic Effects of Tranexamic Acid in Cesarean Delivery: An Ancillary Study of the TRAAP2 Study

Stéphanie Roullet

¹Pôle d'Anesthésie-Réanimation, CHU Bordeaux, Bordeaux, France

²INSERM, Biologie des Maladies Cardiovasculaires, University of Bordeaux, U1034, Pessac, France

,

Timothée Rivoire

¹Pôle d'Anesthésie-Réanimation, CHU Bordeaux, Bordeaux, France

,

Clémence Houssin

³Département de Gynécologie et Obstétrique, CHU Bordeaux, Bordeaux, France

,

Sylvie Labrouche

²INSERM, Biologie des Maladies Cardiovasculaires, University of Bordeaux, U1034, Pessac, France

⁴Laboratoire d'hématologie, CHU Bordeaux, Bordeaux, France

,

Sandrine Paquin

¹Pôle d'Anesthésie-Réanimation, CHU Bordeaux, Bordeaux, France

,

Karine Nouette-Gaulain

¹Pôle d'Anesthésie-Réanimation, CHU Bordeaux, Bordeaux, France

⁵INSERM, Maladies Rares: Génétique et Métabolisme, University of Bordeaux, Bordeaux, France

,

Catherine Deneux-Tharaux

⁶INSERM, Perinatal Obstetrical and Pediatric Epidemiology Research Team (EPOPé), Centre for Research on Epidemiology and Statistics (CRESS), Paris University, Paris, France

,

Jean Amiral

⁷SH-Consulting, Andrésy, France

,

Chloé James

²INSERM, Biologie des Maladies Cardiovasculaires, University of Bordeaux, U1034, Pessac, France

⁴Laboratoire d'hématologie, CHU Bordeaux, Bordeaux, France

,

Loïc Sentilhes

³Département de Gynécologie et Obstétrique, CHU Bordeaux, Bordeaux, France

› Author Affiliations

Abstract

Background Fibrinolysis activation during delivery contributes to postpartum hemorrhage (PPH). Clot lysis time studied with the global fibrinolytic capacity device (GFC/LT) is a functional test which rapidly assesses fibrinolytic profile. Tranexamic acid (TXA) is an efficient antifibrinolytic therapy.

Methods We prospectively studied fibrinolysis and coagulation in 33 women included in the TRAAP2 trial, which aimed to assess the impact of TXA in preventing PPH following a cesarean delivery. TXA or placebo was randomly administered after childbirth as part of the TRAAP2 trial's protocol. Fibrinolytic (GFC/LT, plasma concentration of fibrinolysis activators and inhibitors) and hemostatic parameters were assayed at three sample times (TREF [T-reference] after anesthesia, T15 and T120minutes after TXA, or placebo administration).

Results All cesarean deliveries were elective. In the placebo group, the clot lysis time assessed with GFC/LT significantly decreased between TREF and T120, indicating an activated fibrinolysis (44 [interquartile range, IQR: 40–48] vs. 34 [IQR: 30–36] minutes, p<0.001). In both TXA and placebo groups, significant fluctuations of the plasmatic concentrations of fibrinolytic mediators were noticed over time, suggesting fibrinolysis activation. Clot lysis time measured by GFC/LT was significantly increased in women of the TXA group as compared with those in the placebo group at T15 (120 [120–120] vs. 36 [34–41] minutes, p<0.001) and T120minutes (113 [99–120] vs. 34 [30–36] minutes, p<0.001) after drug administration, indicating a decreased in fibrinolysis in those women.

Conclusion GFC/LT evidenced fibrinolysis activation during cesarean delivery, linked to a decrease in fibrinolytic inhibitors. GFC/LT revealed a significant antifibrinolytic effect of TXA compared with placebo.

Keywords

cesarean delivery - fibrinolysis - global fibrinolytic capacity - postpartum hemorrhage - tranexamic acid

Full Text

References

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