Abstract
Background: Postpartum haemorrhage (PPH) is a leading cause of maternal death. Tranexamic acid has the potential to reduce bleeding and a large randomized controlled trial of its effect on maternal health outcomes in women with PPH (The WOMAN trial) is ongoing. We will examine the effect of tranexamic acid on fibrinolysis and coagulation in a subset of WOMAN trial participants. Methods. Adult women with clinically diagnosed primary PPH after vaginal or caesarean delivery are eligible for inclusion in the WOMAN trial. In a sub-group of trial participants, blood samples will be collected at baseline and 30 minutes after the first dose of tranexamic acid or matching placebo. Our primary objective is to evaluate the effect of tranexamic acid on fibrinolysis. Fibrinolysis will be assessed by measuring D-dimers and by rotational thromboelastometry (ROTEM). Secondary outcomes are international normalized ratio (INR), prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen, haemoglobin and platelets. We aim to include about 180 women from the University College Hospital, Ibadan in Nigeria. Discussion: This sub-study of WOMAN trial participants should provide information on the mechanism of action of tranexamic acid in women with postpartum haemorrhage. We present the trial protocol and statistical analysis plan. The trial protocol was registered prior to the start of patient recruitment. The statistical analysis plan was completed before un-blinding. Trial registration: The trial was registered: ClinicalTrials.gov, Identifier NCT00872469 https://clinicaltrials.gov/ct2/show/NCT00872469; ISRCTN registry, Identifier ISRCTN76912190 http://www.isrctn.com/ISRCTN76912190 (Registration date: 22/03/2012).
Highlights
Postpartum haemorrhage (PPH) is a leading cause of maternal death
Trauma triggers the release of tissue plasminogen activator (TPA), the enzyme that converts plasminogen to plasmin and the resulting fibrinolysis plays a key role in the pathogenesis of trauma induced coagulopathy
A randomised trial conducted in obstetric centres in France found that the increase in D-dimers can be inhibited by tranexamic acid administration[11]
Summary
Weeks , University of Liverpool, Liverpool, UK. 3. Anne-Sophie Ducloy-Bouthors, CHRU Lille, Lille, France Emmanuelle Jeanpierre, Centre Hospitalier Régional, Lille, France Sophie Susen, University of Lille Nord de France, Lille, France. Keywords Postpartum Haemorrhage, Tranexamic Acid, Fibrinogen, D-dimer, ROTEM article can be found at the end of the article. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
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