Title :

Tranexamic acid dose-response relationship for antifibrinolysis in postpartum haemorrhage during Caesarean delivery: TRACES, a double-blind, placebo-controlled, multicentre, dose-ranging biomarker study.

Author(s) :

Ducloy-Bouthors, Anne-Sophie [Auteur]
Groupe de Recherche sur les formes Injectables et les Technologies Associées - ULR 7365 [GRITA]
Hôpital Jeanne de Flandre [Lille]
Gilliot, Sixtine [Auteur]
Groupe de Recherche sur les formes Injectables et les Technologies Associées - ULR 7365 [GRITA]
Kyheng, Maeva [Auteur]
Service de Biostatistiques [CHRU Lille]
Evaluation des technologies de santé et des pratiques médicales - ULR 2694 [METRICS]
Faraoni, David [Auteur]
Baylor College of Medicine [BCM]
Turbelin, Alexandre [Auteur]
Hôpital Jeanne de Flandre [Lille]
Keita-Meyer, Hawa [Auteur]
Hôpital Louis Mourier - AP-HP [Colombes]
Rigouzzo, Agnès [Auteur]
CHU Trousseau [APHP]
Moyanotidou, Gabriela [Auteur]
Constant, Benjamin [Auteur]
Broisin, Françoise [Auteur]
Gouez, Agnès L. [Auteur]
Favier, Rémi [Auteur]
Peynaud, Edith [Auteur]
Ghesquiere, Louise [Auteur]
Hôpital Jeanne de Flandres
Lebuffe, Gilles [Auteur]
Groupe de Recherche sur les formes Injectables et les Technologies Associées - ULR 7365 [GRITA]
Duhamel, Alain [Auteur]
Evaluation des technologies de santé et des pratiques médicales - ULR 2694 [METRICS]
Service de Biostatistiques [CHRU Lille]
Allorge, Delphine [Auteur]
Toxicologie et Génopathies [CHRU Lille]
Susen, Sophie [Auteur]
Centre Hospitalier Régional Universitaire [CHU Lille] [CHRU Lille]
Récepteurs Nucléaires, Maladies Métaboliques et Cardiovasculaires - U 1011 [RNMCD]
Hennart, Benjamin [Auteur]
Centre Hospitalier Régional Universitaire [CHU Lille] [CHRU Lille]
Toxicologie et Génopathies [CHRU Lille]
Impact de l'environnement chimique sur la santé humaine - ULR 4483 [IMPECS]
Jeanpierre, Emmanuelle [Auteur]
Centre Hospitalier Régional Universitaire [CHU Lille] [CHRU Lille]
Odou, Pascal [Auteur]
Groupe de Recherche sur les formes Injectables et les Technologies Associées - ULR 7365 [GRITA]
Huissoud, Cyril [Auteur]
Garabedian, Charles [Auteur]
Mercier, Frédéric [Auteur]
Barre-Drouard, Catherine [Auteur]
Estevez, Max [Auteur]
Corouge, Julien [Auteur]
Baptiste, Anne-Sophie [Auteur]
Dalmas, Anne-Frédérique [Auteur]
Richart, Pierre [Auteur]
Centre Hospitalier Régional Universitaire [CHU Lille] [CHRU Lille]

Journal title :

Br J Anaesth

Pages :

937-945

Publication date :

2022-10-17

ISSN :

1471-6771

English keyword(s) :

antifibrinolytic drug
D-dimer
fibrinogen
fibrinolysis
plasmin
plasmin–antiplasmin complex
postpartum haemorrhage
thrombin
tranexamic acid

HAL domain(s) :

Sciences du Vivant [q-bio]

English abstract : [en]

BackgroundThe optimal dose of tranexamic acid to inhibit hyperfibrinolysis in postpartum haemorrhage is unclear. Tranexamic Acid to Reduce Blood Loss in Hemorrhagic Cesarean Delivery (TRACES) was a double-blind, ...
Show more >BackgroundThe optimal dose of tranexamic acid to inhibit hyperfibrinolysis in postpartum haemorrhage is unclear. Tranexamic Acid to Reduce Blood Loss in Hemorrhagic Cesarean Delivery (TRACES) was a double-blind, placebo-controlled, randomised, multicentre dose-ranging study to determine the dose–effect relationship for two regimens of intravenous tranexamic acid vs placebo.MethodsWomen experiencing postpartum haemorrhage during Caesarean delivery were randomised to receive placebo (n=60), tranexamic acid 0.5 g (n=57), or tranexamic acid 1 g i.v. (n=58). Biomarkers of fibrinolytic activation were assayed at five time points, with inhibition of hyperfibrinolysis defined as reductions in the increase over baseline in D-dimer and plasmin–antiplasmin levels and in the plasmin peak time.ResultsIn the placebo group, hyperfibrinolysis was evidenced by a mean increase over baseline [95% confidence interval] of 93% [68–118] for D-dimer level at 120 min and 56% [25–87] for the plasmin–antiplasmin level at 30 min. A dose of tranexamic acid 1 g was associated with smaller increases over baseline (D-dimers: 38% [13–63] [P=0.003 vs placebo]; plasmin–antiplasmin: –2% [–32 to 28] [P=0.009 vs placebo]). A dose of tranexamic acid 0.5 g was less potent, with non-significant reductions (D-dimers: 58% [32–84] [P=0.06 vs placebo]; plasmin–antiplasmin: 13% [18–43] [P=0.051]). Although both tranexamic acid doses reduced the plasmin peak, reduction in plasmin peak time was significant only for the 1 g dose of tranexamic acid.ConclusionsFibrinolytic activation was significantly inhibited by a dose of intravenous tranexamic acid 1 g but not 0.5 g. Pharmacokinetic–pharmacodynamic modelling of these data might identify the best pharmacodynamic monitoring criteria and the optimal tranexamic acid dosing regimen for treatment of postpartum haemorrhage.Show less >

Language :

Anglais

Peer reviewed article :

Oui

Audience :

Internationale

Popular science :

Non

Collections :

• Récepteurs nucléaires, Maladies Cardiovasculaires et Diabète (RNMCD) - U1011

Source :

Harvested from HAL