I have previously talked about the use of TXA in reducing hemorrhage including reduction of postpartum hemorrhage. However, I felt that I didn’t emphasize the use of TXA in preventing postpartum hemorrhage. Last year, one of the largest clinical trials was completed and published called WOMAN trial examining the efficacy of TXA in preventing postpartum hemorrhage. In this randomised, double-blind, placebo-controlled trial, over 20,000 patients aged 16 years and older from 193 hospitals in 21 countries with a clinical diagnosis of post-partum haemorrhage after a vaginal birth or cesarean section were recruited. These patients received either 1 g intravenous tranexamic acid or placebo in addition to standard care.
This study demonstrated that mortality rate due to bleeding was significantly reduced in women receiving tranexamic acid compared to the placebo group, especially if TXA was given within 3 h of giving birth. Mortality and morbidity rate including thromboembolic events due to other causes were not different significantly. Hysterectomy rate was not found reduced with tranexamic acid treatment. In summary, the study suggests to use TXA for postpartum haemorrhage, as soon as possible after bleeding onset.
So now we are armed with clinical based evidence to use TXA for postpartum hemorrhage management. I hope this post is helpful for your clinical practice.
WOMAN trial collaborators. Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial. Lancet. 2017 Apr 26. pii: S0140-6736(17)30638-4. doi: 10.1016/S0140-6736(17)30638-4. [Epub ahead of print]