What is the role of tranexamic acid (TXA) in managing severe uterine bleeding?

From the Guidelines

Tranexamic acid (TXA) can effectively stop a uterine bleed by stabilizing blood clots and reducing blood loss, and it is recommended to administer 1 gram of TXA intravenously as soon as possible after bleeding onset, with a potential second dose if bleeding continues or restarts within 24 hours.

Key Points to Consider

• The most recent and highest quality study, published in 2022 1, suggests that TXA should be administered intravenously at a dose of 1 gram as soon as possible after bleeding onset, ideally within 1 to 3 hours, to reduce maternal morbidity and mortality.
• The World Health Organization (WHO) also recommends the use of TXA in the management of post-partum hemorrhage, with a dosing regimen of 1 gram intravenously, potentially followed by a second dose if bleeding continues or restarts within 24 hours 1.
• TXA works by inhibiting plasminogen activation, preventing the breakdown of fibrin clots that form at bleeding sites, making it a valuable treatment option for conditions where increased fibrinolysis contributes to excessive bleeding.
• The use of TXA is generally well-tolerated, but patients should be monitored for rare thromboembolic complications, and it should be used with caution in patients with a history of thromboembolic disorders.

Administration and Dosage

• The recommended dose of TXA is 1 gram intravenously, which can be repeated after 30 minutes if bleeding continues or restarts within 24 hours.
• The administration of TXA should be done as soon as possible after bleeding onset, ideally within 1 to 3 hours, to maximize its effectiveness in reducing blood loss and improving patient outcomes.

Important Considerations

• TXA should be used alongside other treatments, such as hormonal therapies, NSAIDs, or surgical interventions, depending on the underlying cause of bleeding.
• Patients with a history of thromboembolic disorders should be closely monitored, and TXA is contraindicated in those with active thromboembolic disease.
• The use of TXA in the management of severe uterine bleeding is supported by the most recent and highest quality evidence, and it is a crucial component of a comprehensive treatment plan to reduce morbidity, mortality, and improve quality of life.

From the Research

Role of Tranexamic Acid in Managing Uterine Bleeding

• Tranexamic acid (TXA) is an antifibrinolytic agent that has been shown to be effective in managing severe uterine bleeding, particularly in the setting of postpartum hemorrhage (PPH) 2.
• Clinical trials have demonstrated that early administration of TXA is important for efficacy, particularly in trauma and PPH 2.
• TXA has been found to be both effective and safe for decreasing maternal mortality in women with postpartum hemorrhage, and prophylactic use of TXA may decrease the need for packed red blood cell transfusions and/or uterotonics 3.

Efficacy of TXA in Dysfunctional Uterine Bleeding

• A prospective randomized study found that TXA (2 g/day) was an effective and safe option for treating dysfunctional uterine bleeding (DUB), with a mean reduction of blood loss of 60.3% after 3 months 4.
• Another study found that TXA reduced menstrual blood loss by 26%-60% and was significantly more effective than placebo, nonsteroidal anti-inflammatory drugs, oral cyclical luteal phase progestins, or oral etamsylate in treating heavy menstrual bleeding 5.

Medical Management of Abnormal Uterine Bleeding

• Medical management is the first-line approach for treating abnormal uterine bleeding in reproductive-aged women, and TXA is a viable option for acute abnormal uterine bleeding with a normal uterus 6.
• TXA can be used in combination with other medical treatments, such as hormonal methods and nonsteroidal anti-inflammatory drugs, to decrease menstrual bleeding 6.
• TXA is also an option for treating heavy menstrual bleeding in women with inherited bleeding disorders or those on anticoagulation therapy 6.