Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom.
Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom.
Am J Obstet Gynecol MFM. 2023 Feb;5(2S):100722. doi: 10.1016/j.ajogmf.2022.100722. Epub 2022 Aug 19.
The evidence that early tranexamic acid treatment reduces postpartum hemorrhage deaths has major implications for obstetrical care worldwide. Tranexamic acid may also have a role in the prevention of postpartum hemorrhage, but more evidence is needed on the balance of risks and benefits. Most deaths from postpartum hemorrhage are in low- and middle-income countries where tranexamic acid treatment is often unavailable. Several maternal health organizations including the Reproductive Health Supplies Coalition, Clinton Health Access Initiative, Concept Foundation, International Federation of Gynecology and Obstetrics, and Unitaid are working to increase access. However, a wider view of the evidence on tranexamic acid and bleeding shows that it can improve maternal health in many other ways. An appreciation of these other health benefits could facilitate efforts to increase access. By reducing heavy menstrual bleeding, tranexamic acid could reduce the prevalence of maternal anemia, a common and important risk factor for postpartum hemorrhage and other maternal and neonatal outcomes. Further clinical trials of tranexamic acid for the treatment of menstrual bleeding are needed. By reducing surgical bleeding and the need for blood transfusion, tranexamic acid would increase the availability of blood in countries where there is blood shortage so that more blood is available for use in life-threatening bleeding including postpartum hemorrhage. In countries where there is no blood shortage, tranexamic acid use would reduce healthcare costs and prevent transfusion-transmitted infections and reactions. Trauma affects women and men, and violence is a leading cause of death in pregnancy. Increased use of tranexamic acid in trauma would significantly reduce trauma deaths. Efforts to increase the availability and use of tranexamic acid for obstetrical hemorrhage should acknowledge its other health benefits and aim to increase its use across health services more generally.
早期使用氨甲环酸治疗可减少产后出血导致的死亡，这一证据对全球产科护理具有重大意义。氨甲环酸在预防产后出血方面可能也有一定作用，但需要更多关于风险和收益平衡的证据。大多数产后出血死亡发生在中低收入国家，这些国家通常无法获得氨甲环酸治疗。包括生殖健康供应联盟、克林顿健康倡议、概念基金会、国际妇产科联合会和联合国艾滋病规划署在内的多个妇幼保健组织正在努力增加其可及性。然而，更广泛地看待氨甲环酸和出血方面的证据表明，它可以通过多种其他方式改善产妇健康。了解这些其他健康益处可能有助于努力增加其可及性。通过减少月经过多，氨甲环酸可以降低产妇贫血的发生率，贫血是产后出血和其他产妇及新生儿结局的常见且重要的危险因素。需要进一步开展氨甲环酸治疗月经过多的临床试验。通过减少手术出血和输血需求，氨甲环酸将增加在血液短缺国家的血液供应，以便在包括产后出血在内的危及生命的出血情况下有更多血液可供使用。在不存在血液短缺的国家，氨甲环酸的使用将降低医疗保健成本，并预防输血传播感染和反应。创伤影响妇女和男子，暴力是妊娠期间死亡的一个主要原因。在创伤中更多地使用氨甲环酸将显著降低创伤死亡人数。努力增加产科出血时氨甲环酸的可及性和使用率，应承认其对其他健康的益处，并旨在更广泛地增加其在整个卫生服务中的使用。
