WOMAN-PharmacoTXA trial: Study protocol for a randomised controlled trial to assess the pharmacokinetics and pharmacodynamics of intramuscular, intravenous and oral administration of tranexamic acid in women giving birth by caesarean section
Résumé
Background: Intravenous tranexamic acid (TXA) within 3 hours of birth significantly reduces death due to bleeding in women with postpartum haemorrhage (PPH). Most PPH deaths occur in the first hours after giving birth and treatment delay decreases survival. One barrier to rapid TXA treatment is the need for intravenous injection. Intramuscular injection and oral solution of TXA would be easier and faster to administer and would require less training. However, the pharmacokinetics (PK), pharmacodynamics and safety of TXA administered by different routes in pregnant women have not been established. The main aim of this study is to ascertain whether IM and oral solution of TXA will be absorbed at levels sufficient to inhibit fibrinolysis in pregnant women. Methods: WOMAN-PharmacoTXA is a prospective, randomised, open label trial to be conducted in Zambia and Pakistan. Adult women undergoing caesarean section with at least one risk factor for PPH will be included. Women will be randomised to receive one of the following about 1 hour prior to caesarean section: 1-gram TXA IV, 1-gram TXA IM, 4-grams TXA oral solution or no TXA. Randomisation will continue until 120 participants with at least six post randomisation PK samples are included. TXA concentration in maternal blood samples will be measured at baseline and at different time points during 24 hours after receipt of intervention. Blood TXA concentration will be measured from the umbilical cord and neonate. The primary endpoint is maternal blood TXA concentrations over time. Secondary outcomes include umbilical cord and neonate TXA concentration D-dimer concentration, blood loss and clinical diagnosis of PPH, injection site reactions and maternal and neonate adverse events. Discussion: The WOMAN-PharmacoTXA trial will provide important data on pharmacokinetics, pharmacodynamics and safety of TXA after IV, intramuscular and oral administration in women giving birth by caesarean section. Trial registration: ClincalTrials.gov, NCT04274335 (18/02/2020).
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Resources ClincalTrials.gov
NCT04274335 (18/02/2020) Antifibrinolytic
clinical trial
Tranexamic acid
PPH
intramuscular
oral
Pharmacokinetics
Pharmacodynamics
caesarean section COV: Covariate CS: Caesarean Section CRF: Case Report Form CTU: Clinical Trials Unit DMC: Data Monitoring Committee Stochastic Approximation Expectation Maximization SUSAR: Suspected Unexpected Serious Adverse Reaction TXA: Tranexamic Acid
caesarean section COV: Covariate
CS: Caesarean Section
CRF: Case Report Form
CTU: Clinical Trials Unit
DMC: Data Monitoring Committee
Stochastic Approximation Expectation Maximization
SUSAR: Suspected Unexpected Serious Adverse Reaction
TXA: Tranexamic Acid
Domaines
Santé
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