Prevention of Postpartum Hemorrhage With TXA

NCT ID: NCT03326596

Last Updated: 2024-01-26

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

WITHDRAWN

Clinical Phase

PHASE4

Study Classification

INTERVENTIONAL

Study Start Date

2018-04-20

Study Completion Date

2019-09-30

Brief Summary

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Hemorrhage remains the leading cause of maternal death worldwide. Tranexamic acid has been shown to reduce rates of hemorrhage when given prophylactically prior to cesarean delivery. It has also been shown to be an effective treatment in response to hemorrhage after a vaginal delivery. The aim of this study is to assess the impact of TXA on hemorrhage rates when given prophylactically prior to all deliveries.

Detailed Description

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Hemorrhage remains the leading cause of maternal mortality worldwide. In a 2014 systematic analysis of the causes of maternal death, the World Health Organization (WHO) noted that even in the face of interventions developed to actively manage the third stage of labor, 27.1% of maternal deaths were directly attributable to excessive blood loss.

Risk factors for postpartum hemorrhage (PPH) have been identified, but the majority of cases occur in low risk women. As such, the routine use of oxytocin in the third stage of labor is recommended in all women and has been well documented to reduce the risk of excessive blood loss. Uterotonics such as methylergonovine, 15-methyl PGF2α and misoprostol have shown to be particularly useful adjuncts as decreased uterine tone is the most common etiology of blood loss. More recently, tranexamic acid (TXA) has been shown to be efficacious in the prevention of postpartum hemorrhage in certain cohorts.

Tranexamic acid exerts its effect through the binding of plasmin and subsequent inhibition of fibrin degradation. It is regarded as pregnancy category B by the Food and Drug Administration (FDA).

Conditions

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Postpartum Hemorrhage

Study Design

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Allocation Method

NA

Intervention Model

SINGLE_GROUP

Prospective Cohort
Primary Study Purpose

PREVENTION

Blinding Strategy

NONE

Study Groups

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ProphylacticTranexamic Acid

Once consented, patients to receive 1000mg/10ml normal saline infusion of TXA with the delivery of the infant's anterior shoulder.

Group Type EXPERIMENTAL

Tranexamic Acid 1000 mg/10ml normal saline infusion

Intervention Type DRUG

Infusion of Tranexamic Acid (Cyklokapron) to all consented women with the delivery of the anterior shoulder of the infant

Interventions

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Tranexamic Acid 1000 mg/10ml normal saline infusion

Infusion of Tranexamic Acid (Cyklokapron) to all consented women with the delivery of the anterior shoulder of the infant

Intervention Type DRUG

Other Intervention Names

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Cyklokapron

Eligibility Criteria

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Inclusion Criteria

* Pregnant female presenting to Navy Medical Center San Diego for delivery
* Able to speak and understand English
* Planning to deliver at NMCSD

Exclusion Criteria

* Age less than 18 years
* Unable to speak or understand English
* Not planning to deliver at NMCSD
* Planned cesarean hysterectomy
* Current anticoagulant use
* Current subarachnoid hemorrhage
* Any active/current intravascular clotting (i.e. venous thromboembolic events)
* Patients with a hypersensitivity to TXA or any of the ingredients
* Personal history of venous or arterial thrombotic events
* Conditions that predispose patients to thromboembolic events (e.g. thrombophilias, autoimmune diseases such as lupus, active cancer, congestive heart failure, family history of thrombosis in a first degree relative at age \< 30 years) due to increased risk of thrombosis
* Patients taking factor IX complex concentrates or anti-inhibitor coagulant concentrates (e.g. FEIBA NF)
* Eclampsia or seizure disorder because the use of tranexamic acid has been associated with postoperative seizures
* Patients with a baseline creatinine 1.2 or higher, history of renal insufficiency, or renal disease because of the risk of toxicity in patients with preexisting disease
* Patients with frank hematuria because ureteral obstruction due to clot formation has been reported in patients with upper urinary tract bleeding who were treated with tranexamic acid
* Patients with active or history of retinal diseases as cases of central retinal artery and central retinal vein obstruction have been reported in patients treated with intravenous tranexamic acid
* Patients with acquired defective color vision
Minimum Eligible Age

18 Years

Maximum Eligible Age

54 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

Yes

Sponsors

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United States Naval Medical Center, San Diego

FED

Sponsor Role lead

Responsible Party

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Sidrah Malik

Program Director, Obstetrics & Gynecology Residency

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Maureen E Farrell, MD

Role: PRINCIPAL_INVESTIGATOR

United States Naval Medical Center, San Diego,CA

Locations

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Navy Medical Center

San Diego, California, United States

Site Status

Countries

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United States

References

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Say L, Chou D, Gemmill A, Tuncalp O, Moller AB, Daniels J, Gulmezoglu AM, Temmerman M, Alkema L. Global causes of maternal death: a WHO systematic analysis. Lancet Glob Health. 2014 Jun;2(6):e323-33. doi: 10.1016/S2214-109X(14)70227-X. Epub 2014 May 5.

Reference Type BACKGROUND
PMID: 25103301 (View on PubMed)

Zelop CM. Postpartum hemorrhage: becoming more evidence-based. Obstet Gynecol. 2011 Jan;117(1):3-5. doi: 10.1097/AOG.0b013e318202ec9a. No abstract available.

Reference Type BACKGROUND
PMID: 21173639 (View on PubMed)

WHO Recommendations for the Prevention and Treatment of Postpartum Haemorrhage. Geneva: World Health Organization; 2012. Available from http://www.ncbi.nlm.nih.gov/books/NBK131942/

Reference Type BACKGROUND
PMID: 23586122 (View on PubMed)

Sentilhes L, Lasocki S, Ducloy-Bouthors AS, Deruelle P, Dreyfus M, Perrotin F, Goffinet F, Deneux-Tharaux C. Tranexamic acid for the prevention and treatment of postpartum haemorrhage. Br J Anaesth. 2015 Apr;114(4):576-87. doi: 10.1093/bja/aeu448. Epub 2015 Jan 8.

Reference Type RESULT
PMID: 25571934 (View on PubMed)

Novikova N, Hofmeyr GJ, Cluver C. Tranexamic acid for preventing postpartum haemorrhage. Cochrane Database Syst Rev. 2015 Jun 16;2015(6):CD007872. doi: 10.1002/14651858.CD007872.pub3.

Reference Type RESULT
PMID: 26079202 (View on PubMed)

Wang HY, Hong SK, Duan Y, Yin HM. Tranexamic acid and blood loss during and after cesarean section: a meta-analysis. J Perinatol. 2015 Oct;35(10):818-25. doi: 10.1038/jp.2015.93. Epub 2015 Jul 30.

Reference Type RESULT
PMID: 26226243 (View on PubMed)

Simonazzi G, Bisulli M, Saccone G, Moro E, Marshall A, Berghella V. Tranexamic acid for preventing postpartum blood loss after cesarean delivery: a systematic review and meta-analysis of randomized controlled trials. Acta Obstet Gynecol Scand. 2016 Jan;95(1):28-37. doi: 10.1111/aogs.12798. Epub 2015 Nov 12.

Reference Type RESULT
PMID: 26698831 (View on PubMed)

Ker K, Shakur H, Roberts I. Does tranexamic acid prevent postpartum haemorrhage? A systematic review of randomised controlled trials. BJOG. 2016 Oct;123(11):1745-52. doi: 10.1111/1471-0528.14267. Epub 2016 Aug 24.

Reference Type RESULT
PMID: 27558956 (View on PubMed)

CRASH-2 trial collaborators; Shakur H, Roberts I, Bautista R, Caballero J, Coats T, Dewan Y, El-Sayed H, Gogichaishvili T, Gupta S, Herrera J, Hunt B, Iribhogbe P, Izurieta M, Khamis H, Komolafe E, Marrero MA, Mejia-Mantilla J, Miranda J, Morales C, Olaomi O, Olldashi F, Perel P, Peto R, Ramana PV, Ravi RR, Yutthakasemsunt S. Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomised, placebo-controlled trial. Lancet. 2010 Jul 3;376(9734):23-32. doi: 10.1016/S0140-6736(10)60835-5. Epub 2010 Jun 14.

Reference Type RESULT
PMID: 20554319 (View on PubMed)

WOMAN Trial Collaborators. Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial. Lancet. 2017 May 27;389(10084):2105-2116. doi: 10.1016/S0140-6736(17)30638-4. Epub 2017 Apr 26.

Reference Type RESULT
PMID: 28456509 (View on PubMed)

Bouet PE, Ruiz V, Legendre G, Gillard P, Descamps P, Sentilhes L. Policy of high-dose tranexamic acid for treating postpartum hemorrhage after vaginal delivery. J Matern Fetal Neonatal Med. 2016;29(10):1617-22. doi: 10.3109/14767058.2015.1056731. Epub 2015 Jun 29.

Reference Type RESULT
PMID: 26118386 (View on PubMed)

Sujata N, Tobin R, Kaur R, Aneja A, Khanna M, Hanjoora VM. Randomized controlled trial of tranexamic acid among parturients at increased risk for postpartum hemorrhage undergoing cesarean delivery. Int J Gynaecol Obstet. 2016 Jun;133(3):312-5. doi: 10.1016/j.ijgo.2015.09.032. Epub 2016 Feb 16.

Reference Type RESULT
PMID: 26952346 (View on PubMed)

Provided Documents

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Document Type: Study Protocol and Statistical Analysis Plan

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Document Type: Study Protocol: Protocol Cover Page

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Document Type: Informed Consent Form: Informed Consent

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Document Type: Informed Consent Form: Informed Consent Cover Page

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Other Identifiers

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NMCSD.2017.0034

Identifier Type: -

Identifier Source: org_study_id

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