Placenta Accreta Spectrum Prophylactic Therapy for Hyperfibrinolysis with Tranexamic Acid

Area of Science:

• Obstetrics and Gynecology
• Maternal-Fetal Medicine
• Hemorrhagic Disorders

Background:

• Placenta accreta spectrum (PAS) presents management challenges.
• Hyperfibrinolysis is a significant risk during expectant management (EM) of PAS.
• Tranexamic acid (TXA) is a potential prophylactic therapy.

Purpose of the Study:

• To evaluate the safety and efficacy of prophylactic tranexamic acid (TXA) for hyperfibrinolysis during expectant management (EM) in placenta accreta spectrum (PAS).

Main Methods:

• Monocentric retrospective study of 35 patients with PAS from 2005-2021.
• Data collected retrospectively from departmental database.
• Analysis of expectant management outcomes, hyperfibrinolysis onset, and TXA treatment efficacy.

Main Results:

• Expectant management (EM) was planned for 25 patients.
• Uterus-preserving treatment was successful in 72% of patients.
• Tranexamic acid (TXA) treatment for hyperfibrinolysis showed a mean fibrinogen level drop of 29.7%.

Conclusions:

• Expectant management (EM) is a viable and safe treatment for placenta accreta spectrum (PAS).
• Tranexamic acid (TXA) effectively manages hyperfibrinolysis and associated hemorrhage during EM.
• This study is the first to demonstrate successful coagulation monitoring and TXA use in EM for PAS.