Last reviewed: April 2018
Last updated: February  2018

Antifibrinolytic treatment in acute severe hemorrhage must be immediate for maximum survival benefit

Treatment with an antifibrinolytic such as tranexamic acid is known to reduce death from bleeding in patients with trauma and post-partum hemorrhage. Now a new meta-analysis has found strong evidence that even a short delay in treatment reduces the survival benefit from tranexamic acid administration. The data, based on more than 40,000 patients with traumatic or post-partum bleeding, showed:

  • immediate treatment with tranexamic acid improved survival by more than 70% compared with placebo.

  • the survival benefit from tranexamic acid decreased by about 10% for every 15 minutes of treatment delay up until 3 hours, after which there was no benefit.

See Management: approach See Management: treatment algorithm

Original source of update

Summary

Definition

History and exam

Key diagnostic factors

  • vaginal bleeding
  • abdominal pain
  • uterine contractions
  • uterine tenderness

Other diagnostic factors

  • lower back pain
  • fetal death

Risk factors

  • chronic hypertension
  • preeclampsia
  • smoking
  • cocaine use
  • trauma
  • prior cesarean delivery
  • preterm premature rupture of the membranes
  • multiparity
  • advanced maternal age
  • polyhydramnios
  • chorioamnionitis
  • uterine malformations
  • prior placental abruption
  • multifetal gestations
  • oligohydramnios
  • uterine leiomyomas
  • thrombophilias

Diagnostic investigations

1st investigations to order

  • fetal monitoring
  • Hb and Hct
  • coagulation studies
  • Kleihauer-Betke (K-B) test
  • ultrasound
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

Yinka Oyelese

Perinatologist

Atlantic Health System

Morristown

NJ

Disclosures

YO is an author of a number of references cited in this monograph.

Anthony M. Vintzileos

Chairman

Department of Obstetrics and Gynecology

Winthrop University Hospital

Mineola

Professor

Obstetrics, Gynecology, and Reproductive Medicine

Stony Brook School of Medicine

Stony Brook

NY

Disclosures

AMV is a consultant for BD (for development of the ODON fetal extraction device).

Peer reviewers VIEW ALL

Professor of Obstetrics and Gynecology

University of Rochester School of Medicine

Rochester

New York

NY

Disclosures

CG declares that he has no competing interests.

Consultant/Senior Lecturer in Obstetrics and Gynaecology

St George's Hospital

London

UK

Disclosures

AU declares that he has no competing interests.

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