WHO有关氨甲环酸治疗产后出血的推荐意见更新要点 | 中国病理生理学会危重病医学专业委员会
现在的位置: 首页指南导读, 进展交流>正文
WHO有关氨甲环酸治疗产后出血的推荐意见更新要点
2018年01月12日 指南导读, 进展交流 暂无评论

Updated WHO Recommendation on Tranexamic Acid for the Treatment of Postpartum Haemorrhage: Highlights and Key Messages from the World Health Organization’s 2017 Global Recommendation

October 2017

www.mcsprogram.org

Key Messages

The World Health Organization (WHO) recommends early use of intravenous tranexamic acid (TXA) within 3 hours of birth in addition to standard care for women with clinically diagnosed postpartum haemorrhage (PPH) following vaginal birth or caesarean section.

Administration of TXA should be considered as part of the standard PPH treatment package and be administered as soon as possible after onset of bleeding and within 3 hours of birth. TXA for PPH treatment should not be initiated more than 3 hours after birth.

TXA should be used in all cases of PPH, regardless of whether the bleeding is due to genital tract trauma or other causes.

TXA should be administered at a fixed dose of 1 g in 10 mL (100 mg/mL) IV at 1 mL per minute (i.e., administered over 10 minutes), with a second dose of 1 g IV if bleeding continues after 30 minutes.

TXA should be administered via an IV route only for treatment of PPH. Research on other routes of TXA administration is a priority.

Table 1. WHO 2017 recommendation on tranexamic acid for the treatment of postpartum haemorrhage

WHO Recommendation

Service Delivery and Clinical Guidance

Early use of IV TXA (as early as possible after clinical diagnosis of PPH, and only within 3 hours of birth) in addition to standard care is recommended for women with clinically diagnosed PPH following vaginal birth or caesarean section.

Postpartum haemorrhage (PPH) is defined as estimated blood loss of more than 500 mL after a vaginal birth or 1,000 mL after caesarean section, or any blood loss sufficient to compromise haemodynamic stability.
Tranexamic acid (TXA) should be used in all cases of PPH, regardless of whether the bleeding is due to genital tract trauma or other causes.
TXA should be considered to be part of the standard comprehensive PPH treatment package, including medical (uterotonics), nonsurgical, and surgical interventions in accordance with WHO guidelines or adapted local PPH treatment protocols.
TXA should be readily available at all times in the delivery and postpartum areas of facilities providing emergency obstetric care.
TXA is relatively cheap in most contexts, easy to administer, often available in health care settings due to its use in trauma and surgery, has a shelf life of 3 years, and can be stored at room temperature (15–30 C) in many places.a
The reference point for the start of the 3-hour window for starting TXA administration is time of birth. If time of birth is unknown, the best estimate of time of birth should be used as the reference point.
Treatment delay in use of TXA appears to reduce benefit. The benefit appears to decrease by 10% for every 15-minute delay, with no benefit seen after 3 hours.
The point estimates of effect of TXA use beyond 3 hours on death for trauma6 and for PPH were both in the direction of harm, albeit not statistically significant for women with PPH. In view of this evidence, WHO recommends against the use of TXA more than 3 hours after birth.
TXA should be administered at a fixed dose of 1 g in 10 mL (100 mg/mL) IV at 1 mL per minute (i.e., administered over 10 minutes), with a second dose of 1 g IV if bleeding continues after 30 minutes or if bleeding restarts within 24 hours of completing the first dose.
TXA should be administered slowly as an IV injection over 10 minutes, since bolus injection carries a potential risk of transient lowering of blood pressure.
TXA for injection may be mixed with most solutions for infusion, such as electrolyte solutions, carbohydrate solutions, amino acid solutions, and dextran solutions, and can be administered through the same IV cannula used for IV hydration or uterotonic administration. TXA should not be mixed with blood for transfusion, solutions containing penicillin, or mannitol.a
TXA should not be used in women with a clear contraindication to antifibrinolytic therapy, including TXA (e.g., a known thromboembolic event during pregnancy, history of coagulopathy, active intravascular clotting, or known hypersensitivity to TXA).

 

Table 2. What is new about the use of tranexamic acid (TXA) to treat postpartum haemorrhage (PPH) in the 2017 WHO recommendation on TXA for PPH treatment?

Indication

Timing

Dosing

WHO 2012 TXA Recommendation

Use of TXA is recommended for the treatment of PPH if oxytocin and other uterotonics fail to stop the bleeding or if it is thought that the bleeding may be partly due to trauma.

For atonic uterus, use TXA if oxytocin and other uterotonics fail to stop the bleeding.

IV (slowly): 1 g

Repeat after 30 minutes if bleeding continues.

WHO 2017 TXA Recommendation (updated)

Use TXA in all cases of PPH, regardless of whether the bleeding is due to genital tract trauma or other causes.

Use TXA within 3 hours and as early as possible after onset of PPH. Do not initiate TXA more than 3 hours after birth, unless being used for bleeding that restarts within 24 hours of completing the first dose (see dosing).

Fixed dose of 1 g in 10 mL (100 mg/mL) IV at 1 mL per minute (i.e., administered over 10 minutes)

Second dose of 1 g IV if bleeding continues after 30 minutes or if bleeding restarts within 24 hours of completing the first dose

给我留言

您必须 [ 登录 ] 才能发表留言!

×
腾讯微博