Ayub Tiyasha Hosne, Strizek Brigitte, Poetzsch Bernd, Kosian Philipp, Gembruch Ulrich, Merz Waltraut M
Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Venusberg Campus 1, 53127 Bonn, Germany.
Institute for Experimental Hematology and Transfusion Medicine, University Hospital Bonn, Venusberg Campus 1, 53127 Bonn, Germany.
J Clin Med. 2023 Dec 26;13(1):135. doi: 10.3390/jcm13010135.
To report on prophylactic therapy for hyperfibrinolysis with tranexamic acid (TXA) during expectant management (EM) in the placenta accreta spectrum (PAS).
This is a monocentric retrospective study of women with PAS presenting at our hospital between 2005 and 2021. All data were retrospectively collected through the departmental database.
35 patients with PAS were included. EM was planned in 25 patients prior to delivery. Complete absorption of the retained placenta was seen in two patients (8%). Curettage was performed in 14 patients (56%). A hysterectomy (HE) was needed in seven (28%) patients; 18 patients (72%) underwent uterus-preserving treatment without severe complications. The mean duration of EM was 107 days. The mean day of onset of hyperfibrinolysis and beginning of TXA treatment was day 45. The mean nadir of fibrinogen level before TXA was 242.4 mg/dL, with a mean drop of 29.7% in fibrinogen level.
Our data support EM as a safe treatment option in PAS. Hyperfibrinolysis can be a cause of hemorrhage during EM and can be treated with TXA. To our knowledge, this is the first cohort of patients with EM of PAS in whom coagulation monitoring and use of TXA have been shown to successfully treat hyperfibrinolysis.
报告在胎盘植入谱系疾病（PAS）的期待治疗（EM）期间使用氨甲环酸（TXA）预防高纤溶状态的情况。
这是一项对2005年至2021年间在我院就诊的PAS患者的单中心回顾性研究。所有数据均通过科室数据库进行回顾性收集。
纳入35例PAS患者。25例患者在分娩前计划进行EM。2例患者（8%）残留胎盘完全吸收。14例患者（56%）进行了刮宫术。7例患者（28%）需要行子宫切除术；18例患者（72%）接受了保留子宫的治疗且无严重并发症。EM的平均持续时间为107天。高纤溶状态开始和TXA治疗开始的平均天数为第45天。TXA治疗前纤维蛋白原水平的平均最低点为242.4mg/dL，纤维蛋白原水平平均下降29.7%。
我们的数据支持EM作为PAS的一种安全治疗选择。高纤溶状态可能是EM期间出血的一个原因，可用TXA治疗。据我们所知，这是首批PAS患者EM队列，其中凝血监测和TXA的使用已被证明可成功治疗高纤溶状态。
