Clinical Trials Unit, Department of Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, United Kingdom.
Best Pract Res Clin Obstet Gynaecol. 2019 Nov;61:66-74. doi: 10.1016/j.bpobgyn.2019.04.005. Epub 2019 Apr 30.
Tranexamic acid reduces bleeding by inhibiting the breakdown of blood clots. It is cost-effective and heat-stable with a long shelf life. In the WOMAN trial, tranexamic acid reduced deaths due to bleeding with no increase in thromboembolic events. The effect was greatest when women received tranexamic acid within 3 h of childbirth (RR = 0.69, 95% CI 0.52-0.91). The WHO recommends that women with post-partum haemorrhage receive 1 g tranexamic acid intravenously as soon as possible after giving birth, followed by a second dose if bleeding continues after 30 min or restarts within 24 h since the first dose. Urgent treatment is critical because women with post-partum haemorrhage bleed to death quickly, and tranexamic acid is most effective when given early. Evidence suggests there is no benefit when the drug is given more than 3 h after bleeding onset. Alternative routes of administration and use of tranexamic acid in the prevention of post-partum haemorrhage are research priorities.
氨甲环酸通过抑制血块分解来减少出血。它具有成本效益，热稳定性好，保质期长。在 WOMAN 试验中，氨甲环酸可降低出血导致的死亡，而血栓栓塞事件没有增加。在女性分娩后 3 小时内给予氨甲环酸时效果最大（RR=0.69，95%CI 0.52-0.91）。世界卫生组织建议，产后出血的妇女在分娩后尽快静脉注射 1g 氨甲环酸，如果 30 分钟后仍有出血或首次剂量后 24 小时内再次出血，则给予第二剂。紧急治疗至关重要，因为产后出血的妇女很快就会因出血而死亡，并且尽早给予氨甲环酸效果最佳。有证据表明，在出血发生后 3 小时以上给予该药物没有益处。替代给药途径和氨甲环酸在预防产后出血方面是研究重点。
