تأثیر ترانگزامیک اسید خوراکی و وریدی بر کاهش بروز خون‌ریزی پس از زایمان سزارین: یک کارآزمایی بالینی شاهددار تصادفی شده

نوع مقاله : اصیل پژوهشی

نویسندگان

1 استادیار گروه زنان و زایمان، مرکز تحقیقات خونریزی‌های غیرطبیعی رحم، دانشگاه علوم پزشکی سمنان، سمنان، ایران.

2 متخصص زنان و زایمان، فلوشیپ لاپاراسکوپی، بیمارستان زنان آرش، دانشگاه علوم پزشکی تهران، تهران، ایران.

3 پزشک عمومی، دانشکده پزشکی، دانشگاه علوم پزشکی سمنان، سمنان، ایران.

4 استادیار گروه اپیدمیولوژی، مرکز تحقیقات عوامل اجتماعی مؤثر بر سلامت، دانشگاه علوم پزشکی سمنان، سمنان، ایران.

5 استادیار گروه فارماکولوژی، مرکز تحقیقات سرطان، دانشکده داروسازی، دانشگاه علوم پزشکی سمنان، سمنان، ایران.

10.22038/ijogi.2025.86105.6360

چکیده

مقدمه: با توجه به تناقض در اثربخشی انواع خوراکی و تزریقی تجویز ترانگزامیک اسید، مطالعه حاضر با هدف مقایسه تأثیر تجویز فرم­ های خوراکی و تزریقی ترانگزامیک اسید بر کاهش شیوع خون­ریزی­ پس از سزارین انجام شد.
روش‌کار: این مطالعه کارآزمایی بالینی شاهددار تصادفی ‌شده در سال 1403-1402 بر روی ۱۰۰ زن باردار کاندید سزارین غیراورژانسی در بیمارستان امیرالمومنین (ع) سمنان انجام شد. افراد به دو گروه ۵۰ نفره ترانگزامیک اسید وریدی (یک گرم قبل از شروع عمل) و خوراکی (۲ گرم یک­ساعت قبل از شروع عمل) تقسیم شدند. حجم خون­ریزی، سطوح سرمی هموگلوبین و هماتوکریت و عوارض دارویی بین دو گروه مقایسه شد. تجزیه و تحلیل داده‌ها با استفاده از نرم ­افزار آماری SPSS (نسخه­ 16) انجام شد. میزان p کم­تر از 05/0 معنی­ دار در نظر گرفته­ شد.
یافته ­ها: بعد از عمل، در گروه ترانگزامیک اسید خوراکی نسبت به وریدی، تعداد ضربان قلب (021/0=p)، حجم خون­ریزی حین عمل (001/0>p) و شیوع عوارض (016/0=p) با تفاوت معنی­ داری بالاتر و سطوح سرمی هموگلوبین (013/0=p) و هماتوکریت (003/0=p) به‌طور معنی­ داری پایین ­تر بود.
نتیجه ­گیری: ترانگزامیک اسید وریدی، نسبت به نوع خوراکی ضمن اثربخشی مناسب‌تر، در کاهش شیوع خون­ریزی­ پس از سزارین، با عوارض کمتری نیز همراه است.

کلیدواژه‌ها

موضوعات

عنوان مقاله [English]

The Effect of Oral and Intravenous Tranexamic Acid on Reducing the Incidence of Postpartum Hemorrhage after Cesarean Section: A Randomized Controlled Clinical Trial

نویسندگان [English]

  • Satinik Darzi 1
  • Aynaz Boostan 2
  • Sahereh Arabian 1
  • Shaghayegh Tarahomi 3
  • Fatemeh Paknazar 4
  • Elham Saffarieh 1
  • Bahador Bagheri 5
1 Assistant Professor, Department of Obstetrics and Gynecology, Abnormal Uterine Bleeding Research Center, Semnan University of Medical Sciences, Semnan, Iran.
2 Gynecology and Obstetrics Specialist, Laparoscopy Fellowship, Arash Women Hospital, Tehran University of Medical Sciences, Tehran, Iran.
3 General Physician, Faculty of Medicine, Semnan University of Medical Sciences, Semnan, Iran.
4 Assistant Professor, Department of Epidemiology, Social Determinants of Health Research Center, Semnan University of Medical Sciences, Semnan, Iran.
5 Assistant Professor, Department of Pharmacology, Cancer Research Center, School of Pharmacy, Semnan University of Medical Sciences, Semnan, Iran.
چکیده [English]

Introduction: Given the existing discrepancies in the effectiveness of oral and intravenous administration of tranexamic acid, the present study was conducted with aim to compare the impact of the two forms of oral and intravenous tranexamic acid on reducing the incidence of postpartum hemorrhage following cesarean section.
Methods: This randomized controlled clinical trial was conducted during 2023–2024 on 100 pregnant women scheduled for elective cesarean section at Amir al-Momenin Hospital, Semnan. Participants were randomly assigned to two groups of intravenous tranexamic acid group (1 g before surgery) and oral tranexamic acid group (2 g one hour before surgery) (n=50 in each group). Intraoperative blood loss, serum hemoglobin and hematocrit levels, and drug-related side effects were compared between the two groups. Data were analyzed using SPSS software (version 16). P<0.05 was considered statistically significant.
Results: After the surgery, the oral tranexamic acid group compared to the intravenous group showed significantly higher heart rate (p=0.021), intraoperative blood loss (p<0.001), and the incidence of side effects (p=0.016), along with significantly lower serum hemoglobin (p=0.013) and hematocrit levels (p=0.003).
Conclusion: Intravenous tranexamic acid compared to the oral form demonstrated superior effectiveness in reducing postpartum hemorrhage after cesarean section and was associated with fewer side effects.

کلیدواژه‌ها [English]

  • Cesarean section
  • Intraoperative bleeding
  • Postpartum hemorrhage
  • Tranexamic acid

مراجع

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مجله زنان، مامایی و نازایی ایران
دوره 28، شماره 5
مرداد 1404
صفحه 19-28

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