Impact of the 2017 revised Japanese obstetric hemorrhage management guidelines on tranexamic acid use in patients undergoing cesarean delivery: an interrupted time series analysis.

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  • Additional Information
    • Source:
      Publisher: Elsevier Country of Publication: Netherlands NLM ID: 9200430 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1532-3374 (Electronic) Linking ISSN: 0959289X NLM ISO Abbreviation: Int J Obstet Anesth Subsets: MEDLINE
    • Publication Information:
      Publication: <2004->: Amsterdam, The Netherlands : Elsevier
      Original Publication: Edinburgh ; New York : Churchill Livingstone, c1991-
    • Subject Terms:
      Tranexamic Acid*/therapeutic use ; Interrupted Time Series Analysis* ; Cesarean Section* ; Antifibrinolytic Agents*/therapeutic use ; Postpartum Hemorrhage*/drug therapy ; Practice Guidelines as Topic*; Humans ; Female ; Pregnancy ; Adult ; Japan ; Blood Transfusion/statistics & numerical data ; Cohort Studies ; East Asian People
    • Abstract:
      Background: Tranexamic acid is one component of a complex management algorithm for postpartum hemorrhage. In Japan, the 2010 obstetric hemorrhage management guidelines was revised in 2017, adding the recommendation for the administration of tranexamic acid for postpartum hemorrhage. This research aims to delineate the temporal trends in tranexamic acid administration in patients undergoing cesarean deliveries and to examine the impact of the obstetric hemorrhage management guidelines implementation.
      Methods: An interrupted time series analysis was conducted on data from patients who underwent cesarean deliveries from April 2012 to August 2021, sourced from Japan's nationwide health insurance claims database. We examined the trends of tranexamic acid usage and blood transfusion use before and after the implementation of the revised guidelines in 2017.
      Results: The study cohort comprised 91 166 cesarean deliveries. Prior to the guideline implementation, the rate of tranexamic acid usage decreased. Post-guidelines implementation, there was a statistically significant increase in the rate of tranexamic acid use, with a quarterly percentage change of 0.48% (95% confidence interval: 0.36 to 0.60; P < 0.001). The guidelines implementation in 2017 was not significantly associated with a change in the rate of transfusions.
      Conclusions: This interrupted time series analysis demonstrated a significant increase in the rate of tranexamic acid administration following the implementation of the revised guidelines, reversing the previously observed downward trend. Our findings could reflect the impact of the revised guideline on the use of tranexamic acid for postpartum hemorrhage, but this did not translate to fewer blood transfusions.
      (Copyright © 2024 Elsevier Ltd. All rights reserved.)
    • Contributed Indexing:
      Keywords: Cesarean section; Obstetric anesthesia; Postpartum hemorrhage; Tranexamic Acid
    • Accession Number:
      6T84R30KC1 (Tranexamic Acid)
      0 (Antifibrinolytic Agents)
    • Publication Date:
      Date Created: 20240912 Date Completed: 20241019 Latest Revision: 20241023
    • Publication Date:
      20241024
    • Accession Number:
      10.1016/j.ijoa.2024.104258
    • Accession Number:
      39265271