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Federación Mexicana de Ginecología y Obstetricia, A.C.

2018, Number 03

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Ginecol Obstet Mex 2018; 86 (03)

Tranexamic acid: A therapeutic alternative in patients with HELLP syndrome

García TJI, González-Cantú G, González- Robles A, Soto-Zataraín JL

Language: Spanish
References: 26
Page: 165-173
PDF size: 262.23 Kb.


ABSTRACT

Objective: To stablish if the use of tranexamic acid (TXA) in patients with HELLP syndrome improves the clinic curse in general terms.
Material and Method: Analytic, comparative and retrospective study where two groups of patients are included, which assisted to the obstetrics and gynecology service in the Hospital Universitario de Saltillo, where the diagnosis of HELLP syndrome was made. Tranexamic acid was given to one of the groups versus the control group without the drug.
Results: 18 patients were included, 9 in each group. The following was observed respect to the laboratory parameters: platelets greater than 105 vs smaller than 105 in the control group. The lactate dehydrogenase (DHL) had a decrease of 58 vs 16% in the patients without tranexamic acid in the first 48 hours. The aspartate aminotransferase (AST) improved 56 vs 43% in the control group, and the alanine aminotransferase (ALT) improved 31 vs 20% in the control group, both in the first 24 hours. The report of protein quantification in 24 hours was 2867 vs 3378 mg in the control group. The hemoglobin figures remained greater than 11vs 9.92 g/dL of the control group. The days of stay in the intensive care unit (UCI) were 3 vs 4.16 of the control group.
Conclusions: Randomized studies are required with an extended sample, to value the benefits and effects of the tranexamic acid, in this kind of patients. According to the collected data the use of tranexamic acid represents an alternative in the treatment of HELLP syndrome, which provides a clinic benefit.


REFERENCES

  1. Haram K, Svendsen E, Abildgaard U. The HELLP syndrome: clinical issues and management. A Review. BMC Pregnancy Childbirth. 2009;9:8. doi:10.1186/1471-2393-9-8.

  2. Habli M, Eftekhari N, Wiebracht E, et al. Long-term maternal and subsequent pregnancy outcomes 5 years after hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome. Am J Obstet Gynecol. 2009;201:385.e1-.e5.

  3. Sibai BM. Diagnosis, controversies, and management of the syndrome of hemolysis, elevated liver enzymes, and low platelet count. Obstetrics and Gynecology 2004;103:981- 989.

  4. Fitzpatrick KE, Hinshaw K, Kurinczuk JJ, Knight M. Risk factors, management, and outcomes of hemolysis, elevated liver enzymes, and low platelets syndrome and elevated liver enzymes, low platelets syndrome. Obstet Gynecol. 2014;123(3):618-627. doi:10.1097/ AOG.0000000000000140.

  5. Hay JE. Liver disease in pregnancy. Hepatology. 2008;47(3):1067-1076. doi:10.1002/hep.22130.

  6. Roberts JM, Hubel CA. Is oxidative stress the link in the twostage model of pre-eclampsia? Lancet. 1999;354(9181):788- 789. doi:10.1016/S0140-6736(99)80002-6.

  7. Roberts JM, Lain KY. Recent insights into the pathogenesis of pre-eclampsia. Placenta. 2002;23(5):359-372. doi:10.1053/plac.2002.0819.

  8. Roberts JM, Hubel CA. The two stage model of preeclampsia: variations on the theme. Placenta. 2009;30(SUPPL.):32-37. http://www.placentajournal.org/ article/S0143-4004(08)00384-6/fulltext

  9. Joshi D, James A, Quaglia A, Westbrook R, Heneghan M. Liver disease in pregnancy. Lancet 2010; 375: 594-605.

  10. Boregowda G, Shehata HA. Gastrointestinal and liver disease in pregnancy. Best Pract Res Clin Obstet Gynaecol 2013; 27: 835-53.

  11. Sziller I, Hupuczi P, Normand N, Halmos A, Papp Z, Witkin SS. Fas (TNFRSF6) gene polymorphism in pregnant women with hemolysis, elevated liver enzymes, and low platelets and in their neonates. Obstet Gynecol 2006;107(3):582-7.

  12. Nagy B, Savli H, Molvarec A, et al. Vascular endothelial growth factor (VEGF) polymorphisms in HELLP syndrome patients determined by quantitative real time PCR and melting curve analyses. Clinica Chimica Acta 2008;389:126-31.

  13. Muetze S, Leeners B, Ortlepp JR, et al. Maternal factor V Leiden mutation is associated with HELLP syndrome in Caucasian women. Acta Obstetricia et Gynecologica Scandinavica 2008;87:635-42.

  14. Yucesoy G, Ozkan S, Bodur H, et al. Maternal and perinatal outcome in pregnancies complicated with hypertensive disorder of pregnancy: a seven-year experience of a tertiary care center. Arch Gynecol Obstet. 2005;273(1):43-49. doi:10.1007/s00404-005-0741-3.

  15. Yucesoy G, Cakiroglu Y, Bodur H, Ozkan S, Tan T. An analysis of HELLP syndrome cases: Does platelet count predict adverse maternal and fetal outcomes in women with HELLP syndrome? Arch Gynecol Obstet. 2011;283(5):941-945. doi:10.1007/s00404-010-1480-7.

  16. Khumsat R. Incidence and risk factors of HELLP syndrome in thai pregnant women with severe pre-eclampsia. Thai J Obstet Gynaecol 2008;16(4):192-198.

  17. Bauserman M, Lokangaka A, Thorsten V, et al. Risk factors for maternal death and trends in maternal mortality in low- and middle-income countries: A prospective longitudinal cohort analysis. Reprod Health. 2015;12(2). doi:10.1186/1742-4755-12-S2-S5.

  18. Sheppard BL, Bonnar J. Fibrinolysis in decidual spiral arteries in late pregnancy. Thromb Haemost. 1978;39(3):751-8.

  19. James AH, McLintock C, Lockhart E. Postpartum hemorrhage: When uterotonics and sutures fail. Am J Hematol. 2012;87(Suppl. 1). doi:10.1002/ajh.23156.

  20. Al-Zirqi I, Vangen S, Forsen L, et al. Prevalence and risk factors of severe obstetric haemorrhage. BJOG 2008;115:1265-1272.

  21. Novikova N, Hofmeyr GJ. Tranexamic acid for preventing postpartum haemorrhage. Cochrane Database Syst Rev 2010:CD007872.

  22. Sócrates Aedo M, Paulina Lira M, Constanza Rivas E, Patricio Narváez B, Italo Campodónico G. Ácido tranexámico en obstetricia y ginecología. Rev. Obstet. Ginecol. Hosp. Santiago Oriente Dr. Luis Tisné Brousse. 2013;8(3):143-156

  23. Peitsidis P, Kadir RA. Antifibrinolytic therapy with tranexamic acid in pregnancy and postpartum. Expert Opin Pharmacother. 2011;12(4):503-516. doi:10.1517/14656 566.2011.545818.

  24. Ferrer P, Roberts I, Sydenh AME, Blackhall K, Shakur H. Anti-fibrinolytic agents in post partum haemorrhage: a systematic review. BMC Pregnancy and Childbirth 2009;9:29.

  25. Mehmet Armagan Osmanagaoglu, Selen Osmanagaoglu, Hülya Ulusoy, Hasan Bozkaya Maternal outcome in HELLP syndrome requiring intensive care management in a Turkish hospital. Sao Paulo Med J. 2006;124(2):85-9.

  26. Acuerdo AS3.HCT.270116/8.P.DF dictado por el H. Consejo Técnico en la sesión ordinaria celebrada el día 27 de enero de dos mil dieciséis, relativo a la aprobación de los costos unitarios por Nivel de Atención Médica para el ejercicio fiscal 2016. https://dof.vlex.com.mx/vid/acuerdo-acdoas3- hct-594761662




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