Population pharmacokinetics and pharmacodynamics of Tranexamic acid in women undergoing caesarean delivery.
British journal of clinical pharmacology
KL2TR001877/UL1TR001876/NH/NIH HHS/United States
TXA; population pharmacodynamics; population pharmacokinetics; post-partum haemorrhage; prophylaxis.
AIMS: The population pharmacokinetics (PK) and pharmacodynamics (PD) of tranexamic acid (TXA) have not been studied to prevent postpartum haemorrhage (PPH) in pregnant women. It is unclear which TXA dose assures sufficient PPH prevention. This study investigated population PK/PD of TXA in pregnant women who underwent caesarean delivery to determine the optimal prophylactic doses of TXA for future studies.
METHODS: We analysed concentration (PK) and maximum lysis (PD) data from 30 pregnant women scheduled for caesarean delivery who received 5, 10 or 15 mg/kg of TXA intravenously using population approach.
RESULTS: TXA PK was best described by a two-compartment model with first-order elimination and the following parameters: clearance (between-subject variability) of 9.4 L/h (27.7%), central volume of 10.1 L (47.4%), intercompartmental clearance of 22.4 L/h (66.7%), peripheral volume of 14.0 L (13.1%) and additive error of 1.4 mg/L. The relationship between TXA concentration and maximum lysis was characterized by a sigmoid Emax model with baseline lysis of 97%, maximum inhibition of 89%, IC
CONCLUSION: This is the first population PK and PD study of TXA in pregnant women undergoing caesarean delivery. Our analysis suggests that a 650 mg dose provides adequate PPH prophylaxis up to 1 hour, which is less than the currently used 1000 mg of TXA in pregnant women.
Li, S., Ahmadzia, H. K., Guo, D., Dahmane, E., Miszta, A., Luban, N. L., Berger, J. S., James, A., Wolberg, A., van den Anker, J. N., & Gobburu, J. (2021). Population pharmacokinetics and pharmacodynamics of Tranexamic acid in women undergoing caesarean delivery.. British journal of clinical pharmacology, (). http://dx.doi.org/10.1111/bcp.14767