This was a large, double blinded RCT of women with postpartum hemorrhage who received usual care plus 1g tranexamic acid (TXA) or placebo. 20,000 women were enrolled to detect a mortality difference. If given within 3 hours, mortality decreased from 1.7% in the placebo group to 1.2% in the TXA group, NNT = 200. Earlier administration was better. There was no increase in thromboembolic events in the TXA group. How does this apply to the ED? This may only be applicable for a precipitous delivery with hemorrhage in a remote locale with long transport time. But we can add TXA as an adjunct, in coordination with OB, to the armamentarium of drugs like oxytocin, methylergonovine, carboprost, and misoprotol for postpartum hemorrhage. My plan is still to get them up 4 floors to L&D ASAP.
TXA reduced mortality in women, especially when given in the first 3 hours of postpartum hemorrhage, without increased risk of thromboembolic events. Ryan Radecki with EM Lit of Note puts this article in perspective with his expert analysis. REBEL EM has an excellent play-by-play breakdown of this article.
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]
Peer reviewed by Thomas Davis.