From the Guidelines
Tranexamic acid (TXA) can be given for vaginal bleeding when the bleeding is heavy, particularly in cases of postpartum hemorrhage, as soon as possible within 3 hours of birth at a dose of 1 gram IV over 10 minutes, with a second dose of 1 gram if bleeding continues after 30 minutes or restarts within 24 hours 1.
Key Considerations
- The most recent and highest quality study recommends the use of TXA in postpartum hemorrhage within 3 hours of birth 1.
- The dose of TXA for postpartum hemorrhage is 1 gram IV over 10 minutes, with a second dose of 1 gram if bleeding continues after 30 minutes or restarts within 24 hours 1.
- TXA is contraindicated in patients with active thromboembolic disease, history of thrombosis, or severe renal impairment.
- Side effects of TXA may include nausea, vomiting, and diarrhea.
- It's essential to rule out underlying pathologies such as endometrial cancer, fibroids, or coagulopathies before attributing vaginal bleeding solely to menorrhagia.
Administration and Monitoring
- TXA should be given as part of the standard treatment packages for postpartum hemorrhage, in accordance with WHO guidelines 1.
- Health facilities providing emergency obstetric care should have the necessary supplies and trained staff to administer TXA safely by intravenous infusion 1.
- Treatment with TXA should be avoided in women with a clear contraindication to antifibrinolytic therapy, such as a known thromboembolic event during pregnancy 1.
From the Research
TXa Administration for Vaginal Bleeding
- TXa can be given for vaginal bleeding in the following situations:
- Heavy menstrual bleeding: TXa has been shown to reduce menstrual blood loss by 26%-60% and improve the quality of life of women treated for heavy menstrual bleeding 2
- Postpartum hemorrhage (PPH) after vaginal delivery: TXa reduces the risk of hysterectomy and does not increase the risk of thrombotic events in women with established primary PPH after vaginal delivery 3
- The recommended oral dosage of TXa for heavy menstrual bleeding is 3.9-4 g/day for 4-5 days starting from the first day of the menstrual cycle 2
- For PPH after vaginal delivery, a dose of 1 g TXa can be given, with a second dose of 1 g if bleeding continues after 30 minutes 3
- TXa can also be used to prevent PPH after vaginal birth, although the evidence is not conclusive, and it may result in little to no difference in blood loss ≥ 500 mL and likely little to no difference in blood loss ≥ 1000 mL or the risk of severe morbidity 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
- Contraindications for TXa use include active thromboembolic disease, history of thrombosis or thromboembolism, or an intrinsic risk for thrombosis or thromboembolism 2