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Impact of the 2017 revised Japanese obstetric hemorrhage management guidelines on tranexamic acid use in patients undergoing cesarean delivery: an interrupted time series analysis.
Yonekura, H; Mazda, Y; Noguchi, S; Berg, B W.
Afiliación
  • Yonekura H; Sim Tiki Simulation Center, John A. Burns School of Medicine, University of Hawaii at Manoa, USA; Department of Anesthesiology and Pain Medicine, Fujita Health University Bantane Hospital, Japan. Electronic address: hyonekur@hawaii.edu.
  • Mazda Y; Department of Obstetric Anesthesiology, Center for Maternal-Fetal and Neonatal Medicine, Saitama Medical Center, Saitama Medical University, Japan.
  • Noguchi S; Department of Obstetric Anesthesiology, Center for Maternal-Fetal and Neonatal Medicine, Saitama Medical Center, Saitama Medical University, Japan.
  • Berg BW; Sim Tiki Simulation Center, John A. Burns School of Medicine, University of Hawaii at Manoa, USA.
Int J Obstet Anesth ; 60: 104258, 2024 Nov.
Article en En | MEDLINE | ID: mdl-39265271
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.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Ácido Tranexámico / Cesárea / Guías de Práctica Clínica como Asunto / Análisis de Series de Tiempo Interrumpido / Hemorragia Posparto / Antifibrinolíticos Límite: Adult / Female / Humans / Pregnancy País/Región como asunto: Asia Idioma: En Revista: Int J Obstet Anesth Asunto de la revista: ANESTESIOLOGIA / OBSTETRICIA Año: 2024 Tipo del documento: Article Pais de publicación: Países Bajos
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Ácido Tranexámico / Cesárea / Guías de Práctica Clínica como Asunto / Análisis de Series de Tiempo Interrumpido / Hemorragia Posparto / Antifibrinolíticos Límite: Adult / Female / Humans / Pregnancy País/Región como asunto: Asia Idioma: En Revista: Int J Obstet Anesth Asunto de la revista: ANESTESIOLOGIA / OBSTETRICIA Año: 2024 Tipo del documento: Article Pais de publicación: Países Bajos