D. Faraoni , C. Carlier , C.M. Samama , J.H. Levy , A.S. Ducloy-Bouthors
{"title":"氨甲环酸预防和/或治疗产后出血的有效性和安全性:一项系统的文献综述和荟萃分析","authors":"D. Faraoni , C. Carlier , C.M. Samama , J.H. Levy , A.S. Ducloy-Bouthors","doi":"10.1016/j.annfar.2014.07.748","DOIUrl":null,"url":null,"abstract":"<div><h3>Objective(s)</h3><p>Assess the efficacy and safety of tranexamic acid administration for the prevention and/or the treatment of postpartum haemorrhage.</p></div><div><h3>Study design</h3><p>Systematic review with meta-analysis.</p></div><div><h3>Material and methods</h3><p>Systematic review of the literature with the aim of identifying prospective, randomised, controlled trials that assessed the effect of tranexamic acid on peripartum blood loss and transfusion requirement in three clinical contexts: (i) prevention of post-partum haemorrhage in case of elective caesarean section, (ii) prevention of post-partum haemorrhage in case of vaginal delivery, (iii) treatment of post-partum haemorrhage.</p></div><div><h3>Results</h3><p>Prophylactic administration of tranexamic acid reduced blood loss (mean difference for intraoperative blood loss: −177.9<!--> <!-->mL, IC 95%: −189.51 to −166.35, total blood loss: −183.94, IC 95%: −198.29 to −169.60), and the incidence of severe post-partum haemorrhage (OR: 0.49, IC 95%: 0.33 to 0.74). None of the published trials assessed the effect of tranexamic acid on blood products administration or transfusion requirement. Only one study assessed and reported the efficacy of tranexamic acid when administered as a treatment for postpartum haemorrhage. A significant reduction in blood loss was reported within 30<!--> <!-->minutes after randomisation (<em>P</em> <!-->=<!--> <!-->0.03) and confirmed after 6<!--> <!-->hours (median: 170<!--> <!-->mL (58–323) vs 221<!--> <!-->mL (110–543), <em>P</em> <!-->=<!--> <!-->0.04). None of the included studies adequately studied the incidence of side effects after tranexamic acid administration.</p></div><div><h3>Conclusion</h3><p>Although tranexamic acid administration seemed to significantly reduce blood loss and the incidence of severe post-partum haemorrhage, further prospective trials are needed to confirm the efficacy and safety of tranexamic administration in the treatment of postpartum haemorrhage. Those studies should assess the pharmacokinetic profile and the safety of this drug in pregnant women.</p></div>","PeriodicalId":7913,"journal":{"name":"Annales Francaises D Anesthesie Et De Reanimation","volume":"33 11","pages":"Pages 563-571"},"PeriodicalIF":0.0000,"publicationDate":"2014-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.annfar.2014.07.748","citationCount":"9","resultStr":"{\"title\":\"Efficacité et sécurité de l’acide tranexamique en prévention et/ou en traitement de l’hémorragie du post-partum : une revue systématique de la littérature avec méta-analyse\",\"authors\":\"D. Faraoni , C. Carlier , C.M. Samama , J.H. Levy , A.S. Ducloy-Bouthors\",\"doi\":\"10.1016/j.annfar.2014.07.748\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Objective(s)</h3><p>Assess the efficacy and safety of tranexamic acid administration for the prevention and/or the treatment of postpartum haemorrhage.</p></div><div><h3>Study design</h3><p>Systematic review with meta-analysis.</p></div><div><h3>Material and methods</h3><p>Systematic review of the literature with the aim of identifying prospective, randomised, controlled trials that assessed the effect of tranexamic acid on peripartum blood loss and transfusion requirement in three clinical contexts: (i) prevention of post-partum haemorrhage in case of elective caesarean section, (ii) prevention of post-partum haemorrhage in case of vaginal delivery, (iii) treatment of post-partum haemorrhage.</p></div><div><h3>Results</h3><p>Prophylactic administration of tranexamic acid reduced blood loss (mean difference for intraoperative blood loss: −177.9<!--> <!-->mL, IC 95%: −189.51 to −166.35, total blood loss: −183.94, IC 95%: −198.29 to −169.60), and the incidence of severe post-partum haemorrhage (OR: 0.49, IC 95%: 0.33 to 0.74). None of the published trials assessed the effect of tranexamic acid on blood products administration or transfusion requirement. Only one study assessed and reported the efficacy of tranexamic acid when administered as a treatment for postpartum haemorrhage. A significant reduction in blood loss was reported within 30<!--> <!-->minutes after randomisation (<em>P</em> <!-->=<!--> <!-->0.03) and confirmed after 6<!--> <!-->hours (median: 170<!--> <!-->mL (58–323) vs 221<!--> <!-->mL (110–543), <em>P</em> <!-->=<!--> <!-->0.04). None of the included studies adequately studied the incidence of side effects after tranexamic acid administration.</p></div><div><h3>Conclusion</h3><p>Although tranexamic acid administration seemed to significantly reduce blood loss and the incidence of severe post-partum haemorrhage, further prospective trials are needed to confirm the efficacy and safety of tranexamic administration in the treatment of postpartum haemorrhage. 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引用次数: 9
摘要
目的:评价氨甲环酸预防和/或治疗产后出血的有效性和安全性。研究设计:采用荟萃分析的系统评价。材料和方法对文献进行系统回顾，目的是确定前瞻性、随机、对照试验，评估氨甲环酸在三种临床情况下对围产期失血和输血需求的影响:(i)预防择期剖宫产的产后出血，(ii)预防阴道分娩的产后出血，(iii)产后出血的治疗。结果预防应用氨甲环酸可降低出血量(术中出血量平均差值为- 177.9 mL, IC 95%: - 189.51 ~ - 166.35，总出血量平均差值为- 183.94,IC 95%: - 198.29 ~ - 169.60)，减少严重产后出血发生率(OR: 0.49, IC 95%: 0.33 ~ 0.74)。未发表的试验评估氨甲环酸对血液制品管理或输血需求的影响。只有一项研究评估并报告了氨甲环酸治疗产后出血的疗效。随机分组后30分钟内出血量显著减少(P = 0.03)， 6小时后证实出血量显著减少(中位数:170 mL (58-323) vs 221 mL (110-543)， P = 0.04)。纳入的研究均未充分研究氨甲环酸给药后副作用的发生率。结论虽然氨甲环酸能明显降低出血量和严重产后出血的发生率，但仍需进一步的前瞻性试验来证实氨甲环治疗产后出血的有效性和安全性。这些研究应评估该药物在孕妇中的药代动力学特征和安全性。
Efficacité et sécurité de l’acide tranexamique en prévention et/ou en traitement de l’hémorragie du post-partum : une revue systématique de la littérature avec méta-analyse
Objective(s)
Assess the efficacy and safety of tranexamic acid administration for the prevention and/or the treatment of postpartum haemorrhage.
Study design
Systematic review with meta-analysis.
Material and methods
Systematic review of the literature with the aim of identifying prospective, randomised, controlled trials that assessed the effect of tranexamic acid on peripartum blood loss and transfusion requirement in three clinical contexts: (i) prevention of post-partum haemorrhage in case of elective caesarean section, (ii) prevention of post-partum haemorrhage in case of vaginal delivery, (iii) treatment of post-partum haemorrhage.
Results
Prophylactic administration of tranexamic acid reduced blood loss (mean difference for intraoperative blood loss: −177.9 mL, IC 95%: −189.51 to −166.35, total blood loss: −183.94, IC 95%: −198.29 to −169.60), and the incidence of severe post-partum haemorrhage (OR: 0.49, IC 95%: 0.33 to 0.74). None of the published trials assessed the effect of tranexamic acid on blood products administration or transfusion requirement. Only one study assessed and reported the efficacy of tranexamic acid when administered as a treatment for postpartum haemorrhage. A significant reduction in blood loss was reported within 30 minutes after randomisation (P = 0.03) and confirmed after 6 hours (median: 170 mL (58–323) vs 221 mL (110–543), P = 0.04). None of the included studies adequately studied the incidence of side effects after tranexamic acid administration.
Conclusion
Although tranexamic acid administration seemed to significantly reduce blood loss and the incidence of severe post-partum haemorrhage, further prospective trials are needed to confirm the efficacy and safety of tranexamic administration in the treatment of postpartum haemorrhage. Those studies should assess the pharmacokinetic profile and the safety of this drug in pregnant women.
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