Tranexamic Acid (TA) vs Combined Oral Contraceptive (COCP) Pilot Study
| Status: | Completed |
|---|---|
| Healthy: | No |
| Age Range: | Any - 21 |
| Updated: | 4/21/2016 |
| Start Date: | August 2011 |
| End Date: | June 2013 |
Prospective Crossover Trial of Oral Tranexamic Acid and Combined Oral Contraceptive in Adolescents With Menorrhagia - A Pilot Study
Menorrhagia, considered a public health challenge and reported by 5 to 10% of adult women,
is encountered even more frequently in adolescents. Surveys of school students in the United
States (US) and Europe reported menorrhagia in 37% to 55% of adolescent females. Medical
management of adolescent menorrhagia includes various formulations of hormonal therapy and
the antifibrinolytic agent epsilon aminocaproic acid. Oral tranexamic acid (TA), a more
potent antifibrinolytic agent used as standard therapy for menorrhagia in adult women and in
adolescent women in Europe and Canada, was not previously available in the US. Subsequent to
US FDA approval in November 2009 of a novel oral TA formulation to treat cyclic heavy
menstrual bleeding in adult women, this medication is currently included in the treatment
armamentarium for adult menorrhagia. There is currently no preliminary data available in the
US about the clinical use of oral TA in an exclusive adolescent population with menorrhagia.
Oral contraceptive pills (OCP) are considered standard therapy in the management of
menorrhagia in teen-aged women. Oral TA has been shown to be more efficacious than
progesterone-only hormonal therapy for menorrhagia in adult women. However, there is no data
available comparing the efficacy of oral TA and combined OCP (COCP) in adult women or in
adolescents with menorrhagia.
The study hypothesis is that, in adolescent menorrhagia, oral TA will have comparable
efficacy in reducing menstrual blood loss (MBL) and improving quality of life (QOL) when
compared to the commonly prescribed COCP.
This hypothesis was tested by comparing the efficacy of these two medications, in a
prospective randomized crossover trial in post-menarchal young girls with menorrhagia.
is encountered even more frequently in adolescents. Surveys of school students in the United
States (US) and Europe reported menorrhagia in 37% to 55% of adolescent females. Medical
management of adolescent menorrhagia includes various formulations of hormonal therapy and
the antifibrinolytic agent epsilon aminocaproic acid. Oral tranexamic acid (TA), a more
potent antifibrinolytic agent used as standard therapy for menorrhagia in adult women and in
adolescent women in Europe and Canada, was not previously available in the US. Subsequent to
US FDA approval in November 2009 of a novel oral TA formulation to treat cyclic heavy
menstrual bleeding in adult women, this medication is currently included in the treatment
armamentarium for adult menorrhagia. There is currently no preliminary data available in the
US about the clinical use of oral TA in an exclusive adolescent population with menorrhagia.
Oral contraceptive pills (OCP) are considered standard therapy in the management of
menorrhagia in teen-aged women. Oral TA has been shown to be more efficacious than
progesterone-only hormonal therapy for menorrhagia in adult women. However, there is no data
available comparing the efficacy of oral TA and combined OCP (COCP) in adult women or in
adolescents with menorrhagia.
The study hypothesis is that, in adolescent menorrhagia, oral TA will have comparable
efficacy in reducing menstrual blood loss (MBL) and improving quality of life (QOL) when
compared to the commonly prescribed COCP.
This hypothesis was tested by comparing the efficacy of these two medications, in a
prospective randomized crossover trial in post-menarchal young girls with menorrhagia.
Subjects were randomized to one of two groups (group A or B).
Group A received oral tranexamic acid at 1300 mg (two 650mg tablets), three times each day
on days 1 to 5 of menstrual cycle for 3 cycles.
Group B received combined oral contraceptive pills (OCP) with 3 weeks of hormonal pills and
1 week of placebo for 3 cycles.
After 3 cycles of therapy, both groups had one cycle without any therapy. Then, the groups
crossed over. Group A, who first received TA, then received OCP. Group B, who first received
OCP, then received TA.
All subjects were to receive both tranexamic acid and oral contraceptive pills.
There were a total of 3 study-associated visits per patient: 1 at baseline and 2 at the end
of 3 cycles on each medication. These visits were considered within standard of care, as
subjects with menorrhagia have frequent monitoring until the effectiveness of the treatment
is determined.
At the study visits the following were done:
1. Assessment of the last menstrual period (amount of blood lost) using the Pictorial
Blood Assessment Chart (PBAC) score and the number of days the period lasted
2. Quality of Life evaluation - by the patient completing a standardized pediatric quality
of life (PedsQL) questionnaire
3. Detailed history and physical examination to evaluate for drug side effects and to look
for signs of blood clots.
4. Blood drawn for a complete blood count.
Group A received oral tranexamic acid at 1300 mg (two 650mg tablets), three times each day
on days 1 to 5 of menstrual cycle for 3 cycles.
Group B received combined oral contraceptive pills (OCP) with 3 weeks of hormonal pills and
1 week of placebo for 3 cycles.
After 3 cycles of therapy, both groups had one cycle without any therapy. Then, the groups
crossed over. Group A, who first received TA, then received OCP. Group B, who first received
OCP, then received TA.
All subjects were to receive both tranexamic acid and oral contraceptive pills.
There were a total of 3 study-associated visits per patient: 1 at baseline and 2 at the end
of 3 cycles on each medication. These visits were considered within standard of care, as
subjects with menorrhagia have frequent monitoring until the effectiveness of the treatment
is determined.
At the study visits the following were done:
1. Assessment of the last menstrual period (amount of blood lost) using the Pictorial
Blood Assessment Chart (PBAC) score and the number of days the period lasted
2. Quality of Life evaluation - by the patient completing a standardized pediatric quality
of life (PedsQL) questionnaire
3. Detailed history and physical examination to evaluate for drug side effects and to look
for signs of blood clots.
4. Blood drawn for a complete blood count.
Inclusion Criteria:
1. Menstruating females with menorrhagia or menometrorrhagia referred to hematology or
gynecology clinics at Texas Childrens Hospital. Menorrhagia is defined as regular
periods with heavy menstrual bleeding with a PBAC score greater than 100;
menometrorrhagia is heavy vaginal bleeding occurring at irregular intervals.
2. PBAC Score greater than 100 for 2 consecutive cycles
3. Pelvic ultrasound that excludes pelvic pathology that can cause menorrhagia within 12
months prior to study participation.
4. Normal external genitalia examination within 6 months prior to study participation.
5. Normal thyroid stimulating hormone (TSH) in the last 6 months prior to study
participation.
6. Negative urine or serum pregnancy test within 4 weeks prior to study participation.
Exclusion Criteria:
1. Presence of intra uterine device.
2. Presence of a diagnosed bleeding disorder based on the standard work-up including
complete blood count (CBC), prothrombin time, partial thromboplastin time,
fibrinogen, von Willebrand panel and platelet function analysis (PFA-100) or platelet
aggregation.
3. Intake of medications with increased risk of bleeding
4. Taking herbal products.
5. Sexually active status.
6. Body weight less than 40 kg.
We found this trial at
1
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Baylor College of Medicine Baylor College of Medicine in Houston, the only private medical school...
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