The George Washington University, School of Medicine and Health Sciences, Washington, DC, United States.
Children's National Medical Center, Washington, DC, United States.
Curr Pharm Des. 2019;25(5):549-555. doi: 10.2174/1381612825666190320155337.
Postpartum hemorrhage remains a significant contributor to morbidity and mortality of women of childbearing age worldwide. Trends in both incidence and severity of postpartum hemorrhage are increasing which makes it imperative to identify drugs that could target prevention and/or treatment of these postpartum hemorrhages for women living in high, middle and low-income countries.
We have reviewed current advances in the medical management of postpartum hemorrhage focusing on non-uterotonic therapy. We specifically describe the use and mechanism of action of tranexamic acid (TXA) and fibrinogen concentrate. Furthermore, we address the existing data for using these medications in postpartum hemorrhage, highlighting both strengths and limitations.
This review describes a new generation of medications that are promising for the prevention and/or treatment of postpartum hemorrhage. For patients at risk for significant hemorrhage, TXA has been shown to reduce intraoperative blood loss and can be given as a prophylactic agent. For the treatment of postpartum hemorrhage, early use of TXA has the potential to reduce mortality. In addition, some data exists supporting the use of fibrinogen concentrate, though more studies are required to help formulate guidelines for its use.
A promising new approach for the management of severe postpartum hemorrhage is using medications that alter coagulation. More data are needed to describe ideal patient populations, dosing, the time of administration, and infusion rate.
产后出血仍然是全球育龄妇女发病率和死亡率的重要原因。产后出血的发生率和严重程度都呈上升趋势，因此迫切需要确定能够针对高、中、低收入国家妇女的预防和/或治疗这些产后出血的药物。
我们回顾了产后出血的医学治疗的最新进展，重点关注非子宫收缩剂治疗。我们特别描述了氨甲环酸（TXA）和纤维蛋白原浓缩物的使用和作用机制。此外，我们还针对这些药物在产后出血中的应用，阐述了现有数据，突出了其优缺点。
这篇综述描述了新一代有希望用于预防和/或治疗产后出血的药物。对于有大量出血风险的患者，TXA 已被证明可以减少术中失血量，并且可以作为预防性药物使用。对于产后出血的治疗，早期使用 TXA 有可能降低死亡率。此外，有一些数据支持纤维蛋白原浓缩物的使用，但需要更多的研究来帮助制定其使用指南。
改变凝血的药物为严重产后出血的治疗提供了一个有前景的新方法。需要更多的数据来描述理想的患者人群、剂量、给药时间和输注速度。
