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. 2020 Oct;50(3):746-752.
doi: 10.1007/s11239-020-02141-4.

National trends in tranexamic acid use in the peripartum period, 2015-2019

Homa K Ahmadzia  1 , Elaine B Hynds  2 , Richard L Amdur  3 , Alexis C Gimovsky  2 , Andra H James  4 , Naomi L C Luban  5
Affiliations

National trends in tranexamic acid use in the peripartum period, 2015-2019

Homa K Ahmadzia et al. J Thromb Thrombolysis. 2020 Oct.

Abstract

Background: The purpose of this study was to measure trends in the use of tranexamic acid (TXA) during delivery in the United States and to evaluate demographic data and morbidity outcomes among these patients.

Methods: This retrospective cohort study includes data from 19 hospitals in the Universal Health Services network. We compared rates of TXA use between January 2015 and June 2019 across geographic sectors. We also evaluated associations of demographic variables and perinatal outcomes of women who received TXA.

Results: 209 cases of TXA use were found from analysis of 101,564 deliveries. TXA use increased over time and rates were higher in the West than in Central and East; the slope of increase over years did not differ between regions. Women who received TXA were more likely to have a history of postpartum hemorrhage (59 (28.2%) vs. 2290 (2.2%), P < 0.0001) but were not more likely to have a chronic disease, including diabetes mellitus, hypertension and heart disease. Women who received TXA were more likely to have estimated blood loss greater than or equal to 1000 mL (adjusted odds ratio (aOR) 15.3; 95% CI 11.1-21.1; P < 0.0001). Likelihood of venous thromboembolism was not significantly increased in TXA recipients (aOR 2.0; 95% CI 0.3-14.6; P = 0.49).

Conclusion: Increasing national trends of TXA use in the peripartum period was observed, with variable increases by geographic region. Likelihood of venous thromboembolism was not significantly increased among women who received TXA. Increasing TXA use throughout the country suggests that updated hemorrhage guidelines from national obstetrical organizations can shape clinical practice.

Keywords: Perinatal outcomes; Postpartum hemorrhage; Tranexamic acid; Venous thromboembolism.

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Conflict of interest statement

The authors have no conflict of interest to disclose. All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Homa Ahmadzia, Elaine Hynds, and Richard Amdur. The first draft of the manuscript was written by Elaine Hynds. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Figures

Fig 1.
Fig 1.. Materials & Methods inclusion criteria:
Inclusion criteria for our study included women who delivered at any one of the United Health Services (UHS) hospitals with a labor & delivery unit between January 1, 2015 and June 30, 2019.
Fig 2.
Fig 2.. Incidence of TXA use by year and by region.
Tranexamic acid use rates increased across all sectors between 2015 and 2019
See this image and copyright information in PMC

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