Tranexamic Acid Administered During Cesarean Delivery in High-risk Patients: Maternal Pharmacokinetics, Pharmacodynamics, and Coagulation Status

Abstract

(Am J Obstet Gynecol. 2022;S0002-9378(22)00441-0) Tranexamic acid (TXA) is often used to prevent or reduce postpartum hemorrhage (PPH), reducing the risk of maternal mortality and decreasing the blood transfusion rate. TXA is widely used in clinical practice, but dosing and covariates that affect the effectiveness of the drug have yet to be studied in the obstetric population. The purpose of this study was to evaluate the pharmacokinetics and pharmacodynamics of the current recommended 1 g intravenous dosage of TXA typically administered during cesarean delivery, and in conjunction use rotational thromboelastometry to assess clot formation and fibrinolysis in patients with high risk of PPH. The primary aim was to evaluate the central tendency and variability of TXA plasma concentrations in high-risk patients after the standard dose up to 5 hours after delivery. Secondary aims were to estimate the correlation between TXA plasma concentrations and body mass index, assess coagulation measurements using rotational thromboelastometry, and other outcomes related to PPH, such as changes in hemoglobin and the requirement of blood transfusions.