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Tranexamic Acid for Prevention and Treatment of Postpartum Hemorrhage

An Update on Management and Clinical Outcomes

Ahmadzia, Homa K., MD, MPH*; Phillips, Jaclyn M., MD; Katler, Quinton S., MD, MS; James, Andra H., MD, MPH

Obstetrical & Gynecological Survey: October 2018 - Volume 73 - Issue 10 - p 587–594
doi: 10.1097/OGX.0000000000000597

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.

*Maternal Fetal Medicine Specialist and Assistant Professor in Obstetrics and Gynecology, and

Resident Physician in Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The George Washington University, Washington, DC; and

Maternal Fetal Medicine Specialist and Consulting Professor, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology and Division of Hematology, Department of Medicine, Duke University Medical Center, Duke University, Durham, NC

The authors have disclosed that the U.S. Food and Drug Administration has not approved the use of tranexamic acid as discussed in this article for the treatment of postpartum hemorrhage. Please consult the product’s labeling for approved information.

All authors, faculty, and staff in a position to control the content of this CME activity and their spouses/life partners (if any) have disclosed that they have no financial relationships with, or financial interests in, any commercial organizations pertaining to this educational activity.

Correspondence requests to: Homa K. Ahmadzia, MD, MPH, Department of Obstetrics and Gynecology, The George Washington University, 2150 Pennsylvania Ave NW, Washington, DC 20037. E-mail:

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