TREATMENT WITH TRANEXAMIC ACID DURING PREGNANCY, AND THE RISK OF THROMBOEMBOLIC COMPLICATIONS

Tranexamic acid (AMCA) is an inhibitor of fibrinolysis used to treat f ibrinolytic bleeding (e. g., menorrhagia and gastro-intestinal haemorr hage), and to prevent bleeding at surgery, in cases of abruptio placen tae and general haemorrhage. As AMCA stabilises preformed clots and pr olongs their dissolution, it has been debated whether treatment with A MCA might predispose to thrombosis by depressing the fibrinolytic syst em. Pregnant women constitute a group with low fibrinolytic capacity a nd an increased frequency of thrombosis further increased after Caesar ean section, and are thus more likely to be susceptible to antifibrino lytic therapy. We therefore carried out a retrospective analysis of th e case records of 2,102 patients with various bleeding disorders durin g pregnancy. Of the 256 patients treated with AMCA (mean duration of t reatment, 46 days), 169 were delivered by Caesarean section. Of the re maining 1,846 patients (i. e., controls), 443 were delivered by Caesar ean section. The relationship between the use of AMCA and the occurren ce of thrombo-embolism was calculated with 95% confidence limits. Of t he AMCA treated group (n = 256), two patients - one of whom belonged t o the Caesarean section subgroup (n = 168) - had pulmonary embolism. O f the controls (n = 1,846), three patients had deep vein thrombosis an d one had pulmonary embolism, all four cases belonging to the Caesarea n section subgroup (n = 443). Thus, the findings in this high risk gro up of women with complicated pregnancies, frequently entailing deliver y by Caesarean section, provided no evidence of any thrombogenic effec t of AMCA.