Tranexamic Acid for Prevention and Treatment of Postpartum Hemorrhage: An Update on Management and Clinical Outcomes

Abstract

Importance Postpartum hemorrhage (PPH) remains a major cause of maternal mortality worldwide, occurring in both vaginal and cesarean deliveries. We have witnessed improvements in both prevention and treatment of PPH. Tranexamic acid (TXA) has been investigated as a potential adjunct therapy to uterotonics within this setting. Objective The aim of this article is to summarize existing recommendations on the use of TXA in obstetrics and review current data on clinical outcomes after TXA use. Evidence Acquisition We reviewed guidelines from a number of professional societies and performed an extensive literature search reviewing relevant and current data in this area. Results and Conclusions In the prevention of PPH, TXA use before both vaginal and cesarean deliveries reduces the amount of postpartum blood loss and should be considered in patients at higher risk for hemorrhage. In the treatment of PPH, TXA should be initiated early for maximal survival benefit from hemorrhage, and it provides no additional benefit if administered more than 3 hours from delivery. Overall, current evidence assessing the risks of TXA use in an obstetric population is reassuring. Target Audience Obstetricians and gynecologists, family physicians. Learning Objectives After completing this activity, the learner should be better able to: define the mechanism of action of TXA; evaluate the utility of TXA in prophylaxis and treatment of PPH; define common doses of TXA used in the peripartum period; and assess associated risk and possible adverse outcome when using TXA.

Randomised, controlled, double‐blind study of combination therapy of oral tranexamic acid and topical hydroquinone in the treatment of melasma

“…There was no increase in the incidence of thrombosis in various clinical trials with oral tranexamic acid doses of up to 6000 mg. 24 Some preliminary in vitro studies of TA using thromboelastometry also showed that the administration of TA at greater than 10-fold therapeutic levels in blood from pregnant women before delivery does not increase the hypercoagulable profile. 25 Headache, nausea, menstrual irregularity and back pain are the most commonly reported side effects of TA. 16,23 Contraindications of TA include kidney dysfunction, cardiovascular or respiratory disease, malignancy, current anticoagulant therapy and history of thromboembolic disease.…”

Red blood cell transfusion in obstetrics and its implication for patient blood management: a retrospective analysis in Switzerland from 1998 to 2016

“…Yet, recently there has been more focus on acute treatment of PPH with increased early use of tranexamic acid. Several studies have already shown and currently further studies are ongoing about the effective use of tranexamic acid as a first-line therapy or even prophylactic use for PPH [17,[26][27][28][29]. Other studies have indicated that the administration of carbetocin as well as oxytocin can effectively prevent PPH after vaginal delivery [30,31].…”

A minimally invasive hemostatic strategy in obstetrics aiming to preserve uterine function and enhance the safety of subsequent pregnancies

“…Tranexamic acid is the drug of choice in patients within 3 h after the onset of hemorrhage. 3,33) Fluid therapy, blood transfusion, and antishock therapy should be initiated without delay while paying attention to vital signs. Circulatory maintenance is attempted by rapid administration of colloid solution and albumin solution until a blood transfusion can be administered.…”

“…1,2) Numerous trial-and-error approaches have been taken to secure effective hemostasis for difficult obstetrical uterine hemorrhage cases. 2) Various surgical hemostatic procedures including arterial ligation, supravaginal amputation of the uterus, and hysterectomy, in addition to procedures such as bimanual uterine compression, intrauterine tamponade, uterotonic therapy, administration of tranexamic acid, 3) and treatment of DIC, have been used. Along with the spread of interventional radiology (IVR) techniques in the field of obstetrics, hemostatic management using preventive hemostasis and embolization became feasible in the 1990s, leading to a major advancement in the management of uterine hemorrhage.…”