INTRODUCTION
Bleeding is a recognized complication of both obstetrical and
gynecological procedures. In fact, obstetrical hemorrhage, a major cause
of maternal morbidity1 is the leading cause of
maternal death worldwide2. In gynecology, bleeding
during benign gynecological surgery and due to benign gynecologic
conditions is a major cause of morbidity3. Numerous
studies show that tranexamic acid (TXA) decreases blood loss effectively
in general surgical procedures; especially in trauma
surgery4,5,6,7. The WOMAN trial demonstrates that TXA
use for postpartum hemorrhage (PPH) reduces mortality. When used for
postpartum hemorrhage, it causes no adverse events and most notably, no
thromboembolic events8.The World Health Organization
(WHO) recommends considering TXA in the standard postpartum hemorrhage
protocol for both vaginal and cesarean sections9.
Currently, in the United States, cesarean sections account for 32% of
all deliveries10. The blood loss for a cesarean
delivery averages between 800ml to 1000 ml11.
Approximately 5% of cesarean sections and 1% of vaginal deliveries
require a blood transfusion12. In 2018, births in the
United States totaled 3,791,71213. TXA has been shown
to be an effective medication to decrease bleeding during cesarean
section not only when used acutely but also
prophylactically14,15,16.
TXA has been used since the 1970s as a non-hormonal medication to
decrease menstrual bleeding in women with
menorrhagia17. When compared to placebo it decreases
heavy menses by 40%18. More recently, TXA use has
been expanded to include benign surgical procedures such as hysterectomy
and myomectomy. Hysterectomy is one of the most commonly performed
surgical procedures in the United States, approximately 600,000 are
performed each year. It is estimated that one in nine women will have a
hysterectomy in their lifetime19. In recent years,
randomized control trials and meta-analysis investigating TXA use in
benign gynecology, for both hysterectomies and myomectomies, show an
overall reduction in both total blood loss and need for reoperations due
to postoperative hemorrhage20,21,22.
One commonality of these studies on TXA use is the lack of adverse
events. Venous thromboembolism with the use of TXA for PPH, heavy
menstrual bleeding, or benign gynecologic surgery is not shown to be a
concern. Given these findings and the World Health Organization’s
recommendations, our goal in conducting this study was to achieve a
better understanding of the current use practices of TXA among
obstetricians and gynecologists.