617: Policy of Tranexamic Acid for Treating Postpartum Hemorrhage after a Vaginal Delivery

To determine whether a policy of administation of high-dose tranexamic acid (TA) at the time of diagnosis of postpartum hemorrhage (PPH) could reduce blood loss after vaginal birth. This was a controlled before-after unicentred study. From January 2011 to August 2011, the control group included all patients with PPH ≥ 500 mL after vaginal birth without use of TA. From September 2011 to March 2012, the TA group included all patients with PPH ≥ 500 mL after vaginal birth. Since the publication of the EXADELI trial (Crit Care 2011) our protocol for the management of PPH has included in September 2011 the use of high-dose TA (4g of TA intravenously then 1g/h over 6 hours) from 800 mL of blood loss after vaginal birth. The primary objective was to assess the efficacy of policy of high-dose TA administration in the reduction of blood loss in PPH. The maternal characteristics did not differ between the two groups. The mean estimated blood loss was not significantly lower in the TA group (n=138) compared to the the control group (n=151) (respectively 915.7+/-321mL versus 944.8+/-313,8mL; p = 0.47). The difference between predelivery hemoglobin and postdelivery hemoglobin tended to be lower in the TA group (-2.6 g/dL+/-1,2 versus -2.9 g/dL+/- 1,3 ; p = 0,09) without significance. In the TA group, postpartum iron sucrose injection was significantly less frequent compared to the control group (2.2% vs 9.9% ; p < 0,05). No thrombo-embolism event occurred in both group. A subgroup analysis among women who had an estimated blood loss ≥ 800 mL (indication of a TA administration) showed no significant difference between the two groups. A policy of high-dose TA after a vaginal delivery was not associated with a significant reduction of blood loss. However, its use was associated with a significantly reduced postpartum iron sucrose injection use in this before-after study.Tabled 1Principal characteristics of the participants and assessment of PPH-related outcome*Values are given as mean +/-standard deviation; **The difference between predelivery hemoglobin and postdelivery hemoglobin. Open table in a new tab