Can tranexamic acid (TXA) stop vaginal bleeding?

From the Guidelines

Tranexamic acid (TXA) can be effective in stopping vaginal bleeds, particularly in cases of heavy menstrual bleeding or postpartum hemorrhage, as evidenced by a large, recent, multicenter, international randomized clinical trial 1. When considering the use of TXA to stop vaginal bleeds, it is essential to determine the cause of the bleeding, as it can have various causes, including pregnancy complications, infections, hormonal imbalances, or structural abnormalities that may require different treatments.

• The typical oral dose of TXA for menstrual bleeding is 1,000-1,300 mg three times daily for up to 5 days during menstruation.
• TXA works by inhibiting the breakdown of blood clots, which helps reduce bleeding.
• However, TXA is not appropriate for all types of vaginal bleeding and should not be used without medical evaluation.
• If experiencing abnormal vaginal bleeding, especially if severe or accompanied by pain, dizziness, or other concerning symptoms, seek immediate medical attention.
• A healthcare provider needs to determine the cause of bleeding before recommending TXA or other treatments.
• TXA also carries risks, including potential blood clots, so it should only be used under medical supervision and is contraindicated in women with active thromboembolic disease or certain other conditions. The use of TXA in cases of postpartum hemorrhage has been shown to reduce maternal death due to hemorrhage, with a recommended dose of 1 g intravenously within 3 hours of birth, and a second dose may be given 0.5-23.5 hours later if bleeding persists 1.

From the Research

Efficacy of Tranexamic Acid (TXA) in Stopping Vaginal Bleeds

• TXA is an antifibrinolytic agent that has been shown to be effective in reducing menstrual blood loss and improving heavy menstrual bleeding (HMB) symptoms 2, 3.
• Studies have demonstrated that TXA can reduce menstrual blood loss by approximately 40-60% compared to placebo or no treatment 3.
• TXA has also been found to be superior to oral progestins and as effective as combined oral contraceptives in reducing menstrual blood volume 2.
• The use of TXA for HMB has been associated with a higher likelihood of improvement in symptoms, with 61-83% of women experiencing improvement compared to 46% with progestogens 3.

Safety and Potential Risks of TXA

• The safety profile of TXA is generally considered to be good, with no clear evidence of an increased risk of thromboembolic events in women with HMB 3.
• However, there is some evidence to suggest that TXA may increase the risk of venous thrombosis in patients with gastrointestinal bleeding 4.
• Higher doses of TXA have also been associated with an increased risk of seizures 4.

Clinical Applications of TXA

• TXA is commonly used for the treatment and prophylaxis of bleeding and hyperfibrinolysis in various clinical settings, including surgery, trauma, and postpartum hemorrhage 4, 5, 6.
• The use of TXA has been shown to reduce perioperative blood loss and blood transfusion requirements, making it an important tool in the management of bleeding complications 6.