Effect of Tranexamic Acid in a Cohort of Placenta Accreta Spectrum Patients [ID: 1380346

Abstract

INTRODUCTION: Use of tranexamic acid (TXA) is beneficial in the setting of obstetric hemorrhage. We sought to understand whether patients with placenta accreta spectrum disorder benefit from TXA administration during cesarean hysterectomy. METHODS: This is an IRB-approved retrospective cohort study of participants with suspected placenta accreta spectrum undergoing cesarean hysterectomy in a single hospital system. Those who received TXA were compared to those who did not. The primary outcome was the rate of blood transfusion. Secondary outcomes included maternal intensive care unit (ICU) admission, massive transfusion, length of postoperative stay, operative time, and a composite of adverse maternal outcomes. Chi-square, t tests, and Fisher’s exact test were used to compare baseline characteristics, and a logistic regression was performed with possible confounders. RESULTS: A total of 87 participants met criteria for the study; among those were 35 (40.2%) who received TXA. Baseline characteristics between groups were similar. Although not statistically significant in univariable analysis, there was a trend for those who received TXA to have lower blood loss overall (∼2,000 mL versus ∼2,300 mL, P=.483) and be less likely to require transfusion (48.6% versus 69.2%, P=.053). Further, they were statistically less likely to undergo ICU admission (22.9% versus 60.4%, P=.001). There was no difference in the other secondary outcomes including the combined adverse maternal outcome (40.0% versus 44.2%, P=.695). After controlling for confounders, TXA administration was independently associated with decreased rates of blood transfusion (adjusted odds ratio [aOR] 0.23, 95% CI 0.08–0.68) and ICU admission (aOR 0.16, 95% CI 0.05–0.48). CONCLUSION: Tranexamic acid use in the setting of cesarean hysterectomy for PAS was associated with decreased risks of transfusion and ICU admission.