Severe bleeding after childbirth or post-partum hemorrhage is the leading cause of maternal death worldwide. A recent study found that the anti-fibrinolytic drug tranexamic acid reduces death in women with bleeding due to post-partum hemorrhage with no adverse effects.
More than 100,000 women globally die each year from fatal bleeding after child birth, also known as Post-Partum Hemorrhage (PPH). However, the inexpensive and widely available drug, tranexamic acid (TXA), has the potential to substantially reduce the number of deaths from PPH.
A report published in The Lancet by the WOMAN trial Collaborators at the London School of Hygiene & Tropical Medicine Clinical Trials Unit investigate the effects of tranexamic acid (TXA) in women with post-partum hemorrhage after a vaginal or caesarean section in 193 hospitals in 21 countries. This double-blind randomized placebo-controlled trial was conducted between March 2010 and April 2016, and included 20,060 women aged 16 and older. They were randomized to receive either 1 g (10 mg/mL) of tranexamic acid intravenously at a rate of 1 mL per min or placebo. If bleeding continued after 30 min or stopped and restarted within 24 hours of the first dose, a second dose of 1 g of tranexamic acid or placebo was given. The group found that death due to bleeding was reduced by approximately 30% in the treatment group, if the drug was given within 3 hours of birth. Surgical procedures (laparotomy and hysterectomy) performed to control bleeding were also assessed. TXA reduced the risk of laparotomy but not hysterectomy. The results also showed that the drug reduced the need for urgent surgery to control bleeding by more than 35%.
In conclusion, there was no increase in complications or adverse effects from the drug for either mothers or babies, and when used as a treatment for PPH, tranexamic acid should be given as soon as possible after bleeding onset. Patients were only enrolled in the study if clinicians were uncertain if they would benefit from TXA treatment, a limitation which may cause the benefits of TXA to be underestimated. In addition, TXA was administered intravenously which may not be possible in regions with limited maternal health resources. Further studies are needed to clarify the impact of TXA on hysterectomy prevention.
Written By: Nupur Srivastava, PhD