Dept. of Haematology, St Bartholomew's Hospital, London, UK.
Clinical Trials Unit, London School of Hygiene and Tropical Medicine, London, UK.
Br J Haematol. 2018 Mar;180(6):799-807. doi: 10.1111/bjh.15073. Epub 2018 Jan 9.
Post-partum haemorrhage (PPH) remains the major cause of maternal death worldwide, with the overwhelming majority of bleeding deaths occurring in low income countries. These bleeding deaths occur due to a complex network of biological and socioeconomic factors, including changes to haemostasis and fibrinolysis during pregnancy. Tranexamic acid (TxA) has been shown to reduce death in bleeding trauma patients safely and is effective in reducing bleeding in surgical patients, however its role in PPH has been less well established. We discuss the impact of the recently published World Maternal Antifibrinolytic (WOMAN) trial, which demonstrated a significant reduction in bleeding deaths (Risk ratio 0·81) in women with PPH who received intravenous TxA compared to those receiving placebo. There were no increases in post-partum thrombotic rates in mothers or breast-fed babies. This trial has shown that intravenous TxA can be used safely and effectively to treat PPH, and should be implemented widely to reduce death due to PPH. However, for the full benefit of TxA to be fully realised in resource-constrained settings, the effectiveness of oral or topical administration and/or pre-emptive dosing need to be investigated.
产后出血（PPH）仍然是全世界产妇死亡的主要原因，绝大多数出血性死亡发生在低收入国家。这些出血性死亡是由于生物和社会经济因素的复杂网络引起的，包括怀孕期间止血和纤维蛋白溶解的变化。氨甲环酸（TxA）已被证明可安全减少出血性创伤患者的死亡，并可有效减少手术患者的出血，但它在 PPH 中的作用尚未得到充分确立。我们讨论了最近发表的《世界产妇抗纤维蛋白溶解剂（WOMAN）试验》的影响，该试验表明，与接受安慰剂的患者相比，接受静脉注射 TxA 的 PPH 妇女的出血性死亡（风险比 0·81）显著减少。母亲或母乳喂养的婴儿产后血栓形成率没有增加。该试验表明，静脉注射 TxA 可安全有效地用于治疗 PPH，应广泛实施以降低因 PPH 导致的死亡。然而，为了在资源有限的环境中充分实现 TxA 的全部益处，需要研究口服或局部给药和/或预防性给药的有效性。
