Can tranexamic acid (TXA) stop a uterine hemorrhage?

From the Guidelines

Tranexamic acid (TXA) can be effective in stopping or reducing uterine hemorrhage, particularly when administered early, ideally within 3 hours of bleeding onset, at a dose of 1 gram intravenously, with a second dose if bleeding continues after 30 minutes. This recommendation is based on the most recent and highest quality study, which suggests that TXA can reduce maternal morbidity and mortality in post-partum hemorrhage 1. The World Health Organization (WHO) also strongly recommends the use of TXA in the treatment of post-partum hemorrhage, in addition to standard care, with a fixed dose of 1 g intravenously at 1 mL/min, and a second dose of 1 g intravenously if bleeding continues after 30 minutes, or if bleeding restarts within 24 hours of completing the first dose 1.

The medication works by blocking plasminogen activation, preventing the breakdown of fibrin in blood clots, thus stabilizing clots that have formed. It is essential to note that TXA should be used as part of a comprehensive treatment package for post-partum hemorrhage, which includes fluid replacement, treatment with uterotonics, monitoring of vital signs, and non-surgical and surgical interventions as needed 1.

Some key points to consider when using TXA for uterine hemorrhage include:

• Administering the medication early, ideally within 3 hours of bleeding onset
• Using a dose of 1 gram intravenously, with a second dose if bleeding continues after 30 minutes
• Monitoring patients for potential side effects, such as nausea, vomiting, and headache
• Using TXA with caution in patients with a history of blood clots or certain kidney conditions
• Ensuring that health facilities have the necessary supplies and trained staff to administer TXA safely by intravenous infusion.

Overall, the use of TXA in the treatment of uterine hemorrhage has been shown to be effective in reducing maternal morbidity and mortality, and should be considered as part of standard care for post-partum hemorrhage, as recommended by the WHO 1 and other recent guidelines 1.

From the Research

Uterine Hemorrhage Treatment with Tranexamic Acid (TXA)

• Tranexamic acid (TXA) is an antifibrinolytic agent that has been used to manage bleeding in various clinical contexts, including postpartum hemorrhage (PPH) 2.
• Studies have shown that TXA can reduce menstrual blood loss in women with heavy menstrual bleeding, with a reduction of 34-54% in menstrual blood loss reported in one systematic review 3.
• TXA has also been found to be effective in reducing blood loss during benign gynecologic surgery, such as abdominal myomectomy and hysterectomy 4.
• In the context of uterine hemorrhage, TXA may help accelerate haemostasis in the uteroplacental circulation and prevent further bleeding at the placental site 5.
• The efficacy and safety of TXA for the treatment of bleeding differ according to the clinical context, timing of administration, and dose, with early administration being important for efficacy, particularly in trauma and PPH 2.

Clinical Evidence for TXA in Uterine Hemorrhage

• A prospective randomized study found that TXA (2 g/day) was an effective and safe option for the treatment of dysfunctional uterine bleeding (DUB), with a mean reduction of blood loss of 60.3% after 3 months 6.
• Another study found that TXA was superior to both placebo and oral progestins, and as good as combined oral contraceptives at reducing menstrual blood volume 4.
• A systematic review of 10 studies found that TXA therapy resulted in a significant reduction in menstrual blood loss and improvement in patient quality of life, with no thromboembolic events reported 3.

Safety and Efficacy of TXA

• TXA has been found to be safe and effective for the treatment of heavy menstrual bleeding, with no increased risk of thrombotic events in patients with major bleeding overall 2.
• However, there is evidence of increased risk of venous thrombosis in patients with gastrointestinal bleeding, and increased risk of seizures with the use of higher doses of TXA 2.
• Further studies are needed to understand the mechanisms by which TXA provides benefit, optimal modes of administration and dosing, and its effect in some clinical settings, such as spontaneous intracerebral hemorrhage 2.