SAFETY AND EFFECTIVENESS OF TOPICAL VERSUS SYSTEMIC ADMINISTRATION OF TRANEXAMIC ACID DURING CS IN A TERTIARY CARE HOSPITAL OF NORTHERN PAKISTAN
Main Article Content
Keywords
cesarean, topical, systemic, intraoperative
Abstract
INTRODUCTION: One of the most often carried out surgical operations globally is a caesarean section (CS.). Between 20-30 percent of all deliveries are thought to be managed by CS. Particularly in low- and middle-income nations like Pakistan, globally CS rates are increasing daily. Furthermore, at risk are blood transfusion related complications, delayed wound healing and extended hospital stays. Tranexamic acid enhances surgical hemostasis and helps to stop bleeding.
OBJECTIVE: To compare the effectiveness and safety of topical versus systemic administration of tranexamic acid (TXA) in reducing the intraoperative blood loss during CS.
MATERIAL AND METHODS: From January 2022 to November 2022, the Department of Gynecology & Obstetrics, District Head Quarter Hospital, Rawalpindi, carried out this comparative interventional study. From the labor room, 120 pregnant female receiving simple CS were chosen for this study. Every enrolled patient underwent an obstetric review and a thorough history. Among all the patients, either they kept in Group A (Topical TXA Group) or Group B (Systemic TXA Group). Using a sensitive weighing scale (up to 0.01g accuracy), intraoperative blood loss was calculated at the end of the surgery from all the abdominal sponges used during surgery by standardized gravimetric method i.e. all the gauzes, abdominal sponges and drapes soaked with blood was weighed, so documenting the total blood loss recorded. Suction bottle blood was recorded.
RESULTS: Average age of patients was 28.0+4.74 years, whereas average amount of blood loss among both the groups was 227.55+18.12 vs 262.38+17.86 which was statistically significant (p-value 0.000). Side effects included nausea, vomiting, hypotension and hypertension were also assessed and it was observed that there were statistically significant (p-value 0.000) difference in topical TXA versus systemic TXA pertaining to hypotension (1.7% vs 26.7%), hypertension (3.3% vs 31.7%), nausea (5% vs 6.7%) and vomiting (5% vs 18.3%).
CONCLUSION: The study concluded that topical TXA is both rapid and effective. The incorporation of topical TXA in routine practice may reduce blood loss and minimize the need for surgical interventions to control bleeding. Therefore, enhancing maternal health outcomes through the optimization of TXA utilization in CS.
References
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. Shalaby MA, Maged AM, Al-Asmar A, ElMahy M, Al-Mohamady M, Rund NMA. Safety and efficacy of preoperative tranexamic acid in reducing intraoperative and postoperative blood loss in high-risk women undergoing cesarean delivery: a randomized controlled trial. BMC Pregnancy Childbirth. 2022;22:201-4.
. Ogunkua OT, Duryea EL, Nelson DB. Tranexamic acid for prevention of hemorrhage in elective repeat cesarean delivery-a randomized study. Am J Obstet Gynecol MFM. 2022;4:100573-7.
. Lorf L, Saintal MV. Tranexamic acid for the prevention of loss of blood after cesarean delivery. N Nig J Med. 2022;384:1623–34.
. Amanuel T, Dache A, Dona A. Postpartum Hemorrhage and its Associated Factors Among Women who Gave Birth at Yirgalem General Hospital, Sidama Regional State, Ethiopia. Health Serv Res Manag Epidemiol. 2021;8:23333928211062777.
. Fawcus S, Moodley J. Postpartum haemorrhage associated with caesarean section and caesarean hysterectomy. Best Pract Res Clin Obstet Gynaecol. 2013;27(2):233-49.
. Maswime S, Buchmann EJ. Why women bleed and how they are saved: a cross-sectional study of caesarean section near-miss morbidity. BMC Pregnancy Childbirth. 2017;17(1):15.
. Gari A, Hussein K, Daghestani M, Aljuhani S, Bukhari M, Alqahtani A, Almarwani M. Estimating blood loss during cesarean delivery: A comparison of methods. J Taibah Univ Med Sci. 2022;17(5):732-6.
. Butwick AJ, Ramachandran B, Hegde P, Riley ET, El-Sayed YY, Nelson LM. Risk Factors for Severe Postpartum Hemorrhage After Cesarean Delivery: Case-Control Studies. Anesth Analg. 2017;125(2):523-532.
. Shah A, Palmer AJR, Klein AA. Strategies to minimize intraoperative blood loss during major surgery. Br J Surg. 2020;107(2):e26-e38.
. Kim JH, Joung EJ, Lee SJ, Kwack JY, Kwon YS. Intraoperative bleeding control during cesarean delivery of complete placenta previa with transient occlusion of uterine arteries. Obstet Gynecol Sci. 2015;58(6):522-4.
. American College of Obstetricians and Gynecologists’ Committee on Gynecologic Practice. Topical Hemostatic Agents at Time of Obstetric and Gynecologic Surgery: ACOG Committee Opinion, Number 812. Obstet Gynecol. 2020;136(4):e81-e89.
. Stachowicz AM, Whiteside JL. Topical Hemostatic Agents in Gynecologic Surgery for Benign Indications. Obstet Gynecol. 2020;135(2):463-468.
. McCormack PL. Tranexamic acid: a review of its use in the treatment of hyperfibrinolysis. Drugs. 2012;72(5):585-617.
. Franchini M, Mannucci PMM. The never-ending success story of tranexamic acid in acquired bleeding. Haematologica. 2020;105(5):1201-5.
. Relke N, Chornenki NLJ, Sholzberg M. Tranexamic acid evidence and controversies: An illustrated review. Res Pract Thromb Haemost. 2021;5(5):e12546.
. Koh A, Adiamah A, Gomez D, Sanyal S. Safety and efficacy of tranexamic acid in minimizing perioperative bleeding in extrahepatic abdominal surgery: meta- analysis. BJS open. 2021;5(2):4-7.
. Ker K, Beecher D, Roberts I. Topical application of tranexamic acid for the reduction of bleeding. Cochrane Database Syst Rev. 2013;(7):CD010562.
. Ghaffari Hamedani SMM, Akbari A, Sayaydi S, Zakariaei Z, Moosazadeh M, et al. The topical application of tranexamic acid to control bleeding in inguinal hernia surgery candidate patients: A randomized controlled trial. Ann Med Surg (Lond). 2021;69:102683.
. Naeiji Z, Delshadiyan N, Saleh S, Moridi A, Rahmati N, Fathi M. Prophylactic use of tranexamic acid for decreasing the blood loss in elective cesarean section: A placebo-controlled randomized clinical trial. Journal of Gynecology Obstetrics and Human Reproduction. 2021;50(1):101973.
. Mohamed AE, Kareem A, Hassan SE. Local versus systemic use of tranexamic acid in elective cesarean section. Medical J Cairo Uni. 2021;89:1171-80.
. Vitello DJ, Ripper RM, Fettiplace MR. A Validation Study of the Gravimetric Method of Measuring Blood Loss. J Vet Med. 2015;2015:152730.
. Liu CN, Yu FB, Xu YZ, Li JS, Guan ZH, Sun MN, et al. Prevalence and risk factors of severe postpartum hemorrhage: a retrospective cohort study. BMC Pregnancy Childbirth. 2021;21(1):332.
. Kramer MS, Berg C, Abenhaim H. Incidence, risk factors, and temporal trends in severe postpartum hemorrhage. Am J Obstet Gynecol. 2013;209:e1−7.
. Bellos I, Pergialiotis V. Tranexamic acid for the prevention of postpartum hemorrhage in women undergoing cesarean delivery: an updated meta-analysis. Am J Obstet Gynecol. 2022;226(4):510-23.
. Topsoee MF, Settnes A, Ottesen B, Bergholt T. A systematic review and meta-analysis of the effect of prophylactic tranexamic acid treatment in major benign uterine surgery. Int J Gynaecol Obstet. 2017;136(2):120-7.
. Begley CM, Gyte GM, Devane D, McGuire W, Weeks A, Biesty LM. Active versus expectant management for women in the third stage of labour. Cochrane Database Syst Rev. 2019;2(2):CD007412.
. Pabinger I, Fries D, Schöchl H, Streif W, Toller W. Tranexamic acid for treatment and prophylaxis of bleeding and hyperfibrinolysis. Wien Klin Wochenschr. 2017;129(9-10):303-16.
. Hartland AW, Teoh KH, Rashid MS. Clinical effectiveness of intraoperative tranexamic acid use in shoulder surgery: a systematic review and meta-analysis. Am J Sports Med. 2021;49:3145–54.
. Jafarbegloo E, Faridnyia F, Ahangari R, Mohammadbeigi A. Prophylactic use of tranexamic acid on blood loss in cesarean delivery: a randomized controlled- clinical trial. Trauma Mon 2021;26:19–24.
. Nour D, ElHusseiny T, Osman N. Efficacy and safety of preoperative intravenous tranexamic acid to reduce blood loss during and after elective lower-segment Cesarean delivery. Evid Based Womens Heal J. 2021;11:177–81.
. Wang Y, Liu S, He L. Prophylactic use of tranexamic acid reduces blood loss and transfusion requirements in patients undergoing cesarean section: a meta-analysis. J Obstet Gynaecol Res. 2019;45:1562–75.
. Oseni RO, Zakari M, Adamou N, Umar UA. Effectiveness of preoperative tranexamic acid in reducing blood loss during caesarean section at Aminu Kano Teaching Hospital, Kano: a randomized controlled trial. Pan Afr Med J. 2021;39:34-7.
. Shalaby MA, Maged AM, Al-Asmar A, ElMahy M, Al-Mohamady M, Rund NMA. Safety and efficacy of preoperative tranexamic acid in reducing intraoperative and postoperative blood loss in high-risk women undergoing cesarean delivery: a randomized controlled trial. BMC Pregnancy Childbirth. 2022;22:201-4.
. Ogunkua OT, Duryea EL, Nelson DB. Tranexamic acid for prevention of hemorrhage in elective repeat cesarean delivery-a randomized study. Am J Obstet Gynecol MFM. 2022;4:100573-7.
. Lorf L, Saintal MV. Tranexamic acid for the prevention of loss of blood after cesarean delivery. N Nig J Med. 2022;384:1623–34.
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Published
Dec 20, 2022
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How to Cite
Sobia Nawaz, Saima Bibi, Sara Sheharyar, Sadia Bano, Beenish Altaf, & Faiza Akram. (2022). SAFETY AND EFFECTIVENESS OF TOPICAL VERSUS SYSTEMIC ADMINISTRATION OF TRANEXAMIC ACID DURING CS IN A TERTIARY CARE HOSPITAL OF NORTHERN PAKISTAN. Journal of Population Therapeutics and Clinical Pharmacology, 29(04), 4963-4969. https://doi.org/10.53555/hafkff50
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Author Biographies
Sobia Nawaz
MBBS; FCPS Associate Professor of Gynae. DHQ Teaching Hospital, Rawalpindi.
Saima Bibi
MBBS; FCPS Assistant Professor of Gynae. Holy Family Hospital, Rawalpindi
Sara Sheharyar
MBBS; FCPS Senior Registrar, Holy Family Hospital, Rawalpindi
Sadia Bano
MBBS; FCPS Senior Registrar, Holy Family Hospital, Rawalpindi
Beenish Altaf
MBBS; FCPS Senior Registrar, Holy Family Hospital, Rawalpindi
Faiza Akram
MBBS Registrar. DHQ Teaching Hospital, RawalpindiHow to Cite
Sobia Nawaz, Saima Bibi, Sara Sheharyar, Sadia Bano, Beenish Altaf, & Faiza Akram. (2022). SAFETY AND EFFECTIVENESS OF TOPICAL VERSUS SYSTEMIC ADMINISTRATION OF TRANEXAMIC ACID DURING CS IN A TERTIARY CARE HOSPITAL OF NORTHERN PAKISTAN. Journal of Population Therapeutics and Clinical Pharmacology, 29(04), 4963-4969. https://doi.org/10.53555/hafkff50
