TITLE:
Place of Tranexamic Acid and Fibrinogen Association in the Management of Severe Postpartum Haemorrhage
AUTHORS:
Raja Briki, Fahmi Ferhi, Ons Cherif, Med Amine Saadi, Mouna Derouich, Abdeljalil Khlifi, Sassi Boughizane, Khalil Tarmiz
KEYWORDS:
Postpartum Haemorrhage, Tranexamic Acid, Fibrinogen, Management
JOURNAL NAME:
Open Journal of Obstetrics and Gynecology,
Vol.8 No.11,
September
25,
2018
ABSTRACT: Introduction: Severe postpartum hemorrhage (PPH) is the main cause of death in
Tunisia. Its management is multidisciplinary and requires perfect knowledge of
a regularly updated protocol and consistent with available resources. We
propose an evaluation of the impact of different therapeutic attitudes, in
particular the combination of tranexamic acid and fibrinogen concentrates in
the management of this hemorrhage. Material and Methods: This was a
retrospective, descriptive and analytical study, conducted in the departments
of Gynecology-Obstetrics and Surgical Resuscitation anesthesia of the Farhat
Hached University Hospital, Sousse, Tunisia. The study was conducted over six
years (2009-2014), and included all parturients who were treated for severe PPH
that occurred on a term greater than 24 weeks of amenorrhea. Patients were
divided into two groups according to the study period: 1) Group
1 (G1): from 1 January 2009 to 31 December 2011, 2) Group
2 (G2): from January 1, 2012 to December 31, 2014, a group that benefited
particularly from the combination of tranexamic acid and fibrinogen concentrates
for the management of their PPH. Results: 166 patients were included: 57
in G1 and 109 in G2. The overall incidence of severe PPH was 3.15/1000
deliveries. We noted a significant decrease in the fall of hemoglobin in per
and post haemorrhagic manifestations in favor of G2 with a p value of 0.003 and p = 0.025, respectively. The use of blood transfusion decreased significantly, in frequency and
in number of packed red cells per patient, between the two groups; transfusion
ratio was 1/1.7/1.5 for G1, and 1/2/1.8 for G2. Fluid therapy, use of
macromolecules and catecholamines were less important in G2. The use of
tranexamic acid, fibrinogen and the association of both increased significantly
between the two groups (p 10-4). Haemostasis hysterectomies were less performed (p 10-3) in G2. Conclusion: The management of PPH has
evolved over the years. The use of tranexamic acid in association with
fibrinogen concentrates had proved his interest.