Postpartum haemorrhage related early increase in D-dimers is inhibited by tranexamic acid: haemostasis parameters of a randomized controlled open labelled trial

Abstract Background Beneficial effects of tranexamic acid (TA) have been established in surgery and trauma. In ongoing postpartum haemorrhage (PPH), a moderate reduction of blood loss was observed in a previously published randomized controlled trial. Analysis of haemostasis parameters obtained from samples collected as part of this study are presented. Methods Women with PPH >800 ml after vaginal delivery were assigned to receive either TA (4 g over 1 h, then 1 g per h over six h) (TA) or not (H). A non-haemorrhagic group (NH), Results In H compared with NH group, D-dimers increase (3730 ng ml −1 [2468–8493] vs 2649 [2667–4375]; P +0.0001) and fibrinogen and factor II decrease were observed at enrolment and became maximal 2 h later. When comparing TA to H patients, the increase in Plasmin-Antiplasmin-complexes at +30 min (486 ng ml −1 [340–1116] vs 674 [548–1640]; P +0.03) and D-dimers at +2 h (3888 ng ml −1 [2688–6172] vs 7495 [4400–15772]; P +0.0001) was blunted. TA had no effect on fibrinogen decrease. Conclusions This study provides biological evidence of an early increase in D-dimers and plasmin-antiplasmin complexes associated with active post-partum haemorrhage and its attenuation by the early use of a clinically effective high dose of TA, opening the perspective of dose ranging studies to determinate the optimal dose and timing in this setting. Clinical trial registration ISRCTN09968140.