School of Medicine and Health Sciences, George Washington University, Washington, DC (Ms Sterling and Mr Dazelle).
Department of Obstetrics and Gynecology, George Washington University, Washington, DC (Dr Litman).
Am J Obstet Gynecol MFM. 2023 Jun;5(6):100933. doi: 10.1016/j.ajogmf.2023.100933. Epub 2023 Mar 16.
Results from the 2017 World Maternal Antifibrinolytic trial found that patients who received tranexamic acid during delivery had significantly lower rates of death and hysterectomy. Several months after the World Maternal Antifibrinolytic trial publication, American College of Obstetricians and Gynecologists endorsed the consideration of tranexamic acid usage when traditional uterotonics fail during postpartum hemorrhage. Since then, tranexamic acid usage has become more mainstream for the treatment of postpartum hemorrhage.
This study aimed to evaluate tranexamic acid trends in obstetrics both temporally and geographically within the United States. Additional outcomes included patient demographics and perinatal outcomes.
This retrospective cohort study included 19 hospitals divided into East, Central, and West geographic regions within the Universal Health Services, Incorporated network. Rates of tranexamic acid use were compared from July 2019 through June 2021. Patient demographics and perinatal outcomes were analyzed for tranexamic acid recipients.
During the two-year study period, 3.2% (1580/50,150) of patients received tranexamic acid during delivery. The western region of the United States demonstrated increased tranexamic acid use over the 2-year study period. Recipients of tranexamic acid were more likely to have a history of postpartum hemorrhage (P<.0001), chronic hypertension (P<.0001), preeclampsia (P<.0001), and/or diabetes (P=.004). Patients who received tranexamic acid did not have an increased likelihood of venous thromboembolism in comparison with those who did not receive tranexamic acid (8 [0.5%] vs 226 [0.5%]; P=.77). Of those who received tranexamic acid, 53.2% (840/1580) had an estimated blood loss <1000 mL.
Nationally, a higher percentage of patients received tranexamic acid without a postpartum hemorrhage diagnosis compared with previous studies, and the western region of the United States had an overall increased use of tranexamic acid during delivery compared with previous years. There was no increased risk of venous thromboembolism in those who received tranexamic acid, regardless of postpartum hemorrhage diagnosis.
2017 年世界产妇抗纤维蛋白溶解剂试验的结果表明，分娩时接受氨甲环酸的患者死亡率和子宫切除术率显著降低。世界产妇抗纤维蛋白溶解剂试验发表几个月后，美国妇产科医师学会认可在产后出血时传统宫缩剂失败时考虑使用氨甲环酸。从那时起，氨甲环酸在产后出血的治疗中变得更加主流。
本研究旨在评估美国国内在时间和地理上氨甲环酸在产科中的趋势。其他结果包括患者人口统计学和围产儿结局。
这项回顾性队列研究包括 19 家医院，分为 Universal Health Services, Incorporated 网络中的东部、中部和西部地理区域。比较了 2019 年 7 月至 2021 年 6 月期间使用氨甲环酸的情况。对接受氨甲环酸治疗的患者进行了人口统计学和围产儿结局分析。
在两年的研究期间，3.2%（1580/50150）的患者在分娩时接受了氨甲环酸。美国西部在两年的研究期间增加了氨甲环酸的使用。接受氨甲环酸的患者更有可能有产后出血史（P<.0001）、慢性高血压（P<.0001）、子痫前期（P<.0001）和/或糖尿病（P=.004）。与未接受氨甲环酸的患者相比，接受氨甲环酸的患者发生静脉血栓栓塞的可能性没有增加（8[0.5%]与 226[0.5%]；P=.77）。在接受氨甲环酸的患者中，53.2%（840/1580）的估计失血量<1000 毫升。
在全国范围内，与之前的研究相比，接受氨甲环酸治疗的患者中没有产后出血诊断的比例更高，与前几年相比，美国西部在分娩时使用氨甲环酸的比例总体上有所增加。无论是否有产后出血诊断，接受氨甲环酸的患者发生静脉血栓栓塞的风险均无增加。
