Tranexamic acid, given within 3 h of birth, reduces bleeding deaths in women with postpartum haemorrhage (1):
- WHO recommends that women with post-partum haemorrhage receive 1 g tranexamic acid intravenously as soon as possible after giving birth, followed by a second dose if bleeding continues after 30 min or restarts within 24 h since the first dose
A randomised controlled trial (n=7580) in women with moderate or severe anaemia who had given birth vaginally found giving tranexamic acid within 15 min of the umbilical cord being clamped did not reduce the risk of clinically diagnosed postpartum haemorrhage (7.0% v 6.6% placebo; RR 1.05, 95%CI 0.94–1.19) (2):
- related commentary discussing the results of this analysis alongside other research in this field notes that tranexamic acid should be used in women with substantial bleeding, and consideration should be given to the use of tranexamic acid before a diagnosis of postpartum haemorrhage in women at high risk of death (3)
- suggests that when taken together, the results show that tranexamic acid reduces maternal mortality through the reduction of life-threatening postpartum bleeding, at least in symptomatic women
- has been shown particularly in low-income and middle-income countries, however, RCTs have been unable to show a statistically significant impact of tranexamic acid on maternal mortality in high-income and middle-income countries, where maternal mortality is generally low (so a low event rate in the control group, making it difficult to demonstrate a statistically significant effect)
Reference:
- Brenner A et al. Tranexamic acid for post-partum haemorrhage: What, who and when. Best Pract Res Clin Obstet Gynaecol. 2019 Nov;61:66-74.
- The WOMAN-2 Trial Collaborators. The effect of tranexamic acid on postpartum bleeding in women with moderate and severe anaemia (WOMAN-2): an international, randomised, double-blind, placebo-controlled trial. Lancet October 26, 2024.
- Mol, Ben W J et al. Prevention and treatment of postpartum haemorrhage: progress by learning what works and what does not work. Lancet October 26, 2024.