Abstract
Background
Results from the 2017 World Maternal Antifibrinolytic (WOMAN) trial found that patients
who received tranexamic acid (TXA) during delivery had significantly lower rates of
death and hysterectomy. Several months after the WOMAN trial publication, ACOG endorsed
the consideration of TXA usage when traditional uterotonics fail during postpartum
hemorrhage (PPH). Since then, TXA usage has become more mainstream for the treatment
of PPH.
Objective
This study aimed to evaluate TXA trends in obstetrics both temporally and geographically
within the United States (US). Additional outcomes included patient demographics and
perinatal outcomes.
Study Design
This retrospective cohort study included 19 hospitals, divided into East, Central,
and West geographic regions, within the Universal Health Services, Incorporated network.
Rates of TXA use were compared from July 2019 through June 2021. Patient demographics
and perinatal outcomes were analyzed for TXA recipients.
Results
During the two-year study period, 3.2% (1,580/50,150) of patients received TXA during
delivery. The western region of the US demonstrated increased TXA use over the two-year
study period. Recipients of TXA were more likely to have a history of postpartum hemorrhage
(p < 0.0001), chronic hypertension (p < 0.0001), preeclampsia (p < 0.0001), and/or
diabetes (p = 0.004). Patients who received TXA did not have an increased likelihood
of venous thromboembolism in comparison to those who did not receive TXA (8 [0.5%]
vs. 226 [0.5%], p = 0.77). Of those who received TXA, 53.2% (840/1580) had an estimated
blood loss less than 1000 mL.
Conclusion
Nationally, a higher percentage of patients received TXA without a PPH diagnosis compared
to prior studies, and the western region of the US had an overall increased use in
TXA during delivery compared to prior years. The greatest frequency of TXA use remains
in the western region. There was no increased risk of venous thromboembolism in those
who received TXA, regardless of PPH diagnosis.
Keywords
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Article info
Publication history
Accepted:
March 13,
2023
Received in revised form:
March 10,
2023
Received:
December 7,
2022
Publication stage
In Press Accepted ManuscriptIdentification
Copyright
© 2023 Elsevier Inc. All rights reserved.
