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Written by Millie Cosse
Spoon Feed
Tranexamic acid reduces the risk of life-threatening postpartum bleeding with no measurable increased risk of thrombosis.
TXA Away!
This systematic review and individual patient data meta-analysis analyzed data from 54,404 women in five eligible trials to determine if tranexamic acid could prevent life-threatening bleeding after birth and whether TXA administration had any effect on the likelihood of thromboembolic events. There were fewer deaths within 24-hours (OR 0.76, 95%CI 0.62-0.94) and fewer deaths from bleeding (OR 0.81, 95%CI 0.66-1.00) among women in the TXA group, with no detectable change in rates of thromboembolic events. The authors note that thromboembolic events are rare and imprecisely measured, and despite this data, they cannot exclude a modest increase in thrombosis with TXA. The trials included data from women in both resource-rich and resource-poor countries, suggesting generalizable results.
How will this change my practice?
Currently, WHO recommends TXA for all women with a clinical diagnosis of postpartum hemorrhage, but this paper supports the practice of administering TXA before a clinical diagnosis is made in patients at high risk of death. I’ll be reaching for early TXA in high-risk patients when practicing in a resource-limited setting.
Source
Tranexamic acid for postpartum bleeding: a systematic review and individual patient data meta-analysis of randomised controlled trials. Lancet. 2024 Oct 26;404(10463):1657-1667. doi: 10.1016/S0140-6736(24)02102-0. PMID: 39461793.
