Can tranexamic acid (TXA) stop uterine bleeding?

From the Guidelines

Tranexamic acid (TXA) can effectively stop uterine bleeds, particularly in the context of post-partum haemorrhage, when administered intravenously at a dose of 1 gram over 10 minutes, with a second dose if bleeding continues after 30 minutes, as recommended by the WHO 1.

Mechanism of Action

TXA works by inhibiting plasminogen activation, which prevents the breakdown of blood clots and helps maintain clot stability, making it useful for treating both acute hemorrhage and chronic heavy menstrual bleeding.

Dosage and Administration

For postpartum hemorrhage, the recommended dose is 1 gram IV over 10 minutes, with a second dose if bleeding continues after 30 minutes 1.

Side Effects and Precautions

Side effects are generally mild but can include nausea, vomiting, and headache, and TXA should be used with caution in patients with a history of thromboembolism, and dosage adjustments are necessary for patients with kidney impairment.

Comprehensive Approach

While effective, TXA should be part of a comprehensive approach to managing uterine bleeding, which may include other medications or interventions depending on the underlying cause, such as fluid replacement, treatment with uterotonics, monitoring of vital signs, and non-surgical and surgical interventions 1. Some key points to consider when using TXA to stop uterine bleeds include:

• Early administration is crucial, with the WHO recommending administration within 3 hours of birth 1
• TXA should be given in all cases of post-partum haemorrhage, regardless of whether the bleeding is thought to be due to genital tract trauma or for other reasons, including uterine atony 1
• Health facilities should have the necessary supplies and training for staff to administer TXA safely by intravenous infusion 1

From the Research

Uterine Bleeding Treatment

• Tranexamic acid (TXA) has been shown to be effective in reducing menstrual blood loss by 26%-60% 2
• TXA is significantly more effective than placebo, nonsteroidal anti-inflammatory drugs, oral cyclical luteal phase progestins, or oral etamsylate in treating heavy menstrual bleeding (HMB) 2
• The recommended oral dosage of TXA is 3.9-4 g/day for 4-5 days starting from the first day of the menstrual cycle 2

Postpartum Hemorrhage Treatment

• TXA is used in conjunction with uterotonic agents to treat postpartum hemorrhage (PPH) 3
• The World Health Organization recommends that TXA be part of the standard comprehensive PPH treatment package 3
• Evidence suggests that TXA used prophylactically in the setting of cesarean birth may decrease blood loss and the incidence of PPH 3

Efficacy and Safety of TXA

• TXA has been shown to be safe and effective for the treatment of heavy vaginal bleeding during menstruation and childbirth 4
• TXA improves the quality of life, facilitates participation in school and work, and reduces the risk of death from postpartum hemorrhage 4
• Adverse effects of TXA are few and mainly mild, with no evidence of an increase in the incidence of thrombotic events associated with its use 2, 5

Barriers to Access

• Despite its well-established benefits, individual- and structural-level barriers preclude the widespread utilization of TXA, hindering effective patient care and perpetuating health inequities in women's health 4