What is the dosage of Tranexamic acid (TXA) for uterine hemorrhage?

From the Guidelines

The recommended dosage of Tranexamic acid (TXA) for uterine hemorrhage is 1 gram intravenously, given as soon as possible after the onset of bleeding, with a second dose of 1 gram intravenously if bleeding continues after 30 minutes, or if bleeding restarts within 24 hours of completing the first dose.

Key Considerations

• The World Health Organization (WHO) strongly recommends the use of TXA in the treatment of post-partum hemorrhage, with a fixed dose of 1 g (100 mg/mL) intravenously at 1 mL/min, given over 10 minutes 1.
• The WOMAN trial, a large randomized controlled trial, demonstrated a significant reduction in death from bleeding with the use of TXA in women with post-partum hemorrhage, supporting the use of this dosage 1.
• The timing of TXA administration is critical, with early treatment (within 3 hours of birth) appearing to optimize benefits, and delay in treatment reducing benefit by 10% for every 15 minutes of delay 1.
• TXA should be given as part of the standard treatment packages for post-partum hemorrhage, in accordance with WHO guidelines, which includes fluid replacement, treatment with uterotonics, monitoring of vital signs, and non-surgical and surgical interventions 1.
• The use of TXA is supported by a Cochrane review, which includes the WOMAN trial and another trial, and demonstrates the effectiveness of TXA in reducing bleeding in women with post-partum hemorrhage 1.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Dosage of Tranexamic Acid for Uterine Hemorrhage

• The recommended dosage of Tranexamic acid (TXA) for uterine hemorrhage is 1g intravenously, with a second dose of 1g if bleeding continues 2.
• This dosage is recommended for the treatment of postpartum hemorrhage (PPH), especially when administered shortly after delivery.
• The use of TXA as a preventative measure for PPH is not universally recommended, but it may be considered for patients at higher risk for hemorrhage 3.

Administration Timing

• TXA should be initiated early for maximal survival benefit from hemorrhage, and it provides no additional benefit if administered more than 3 hours from delivery 3.
• The World Health Organization recommends intravenous TXA as an adjuvant therapy for the treatment of PPH, in addition to standard recommended treatments, within three hours of birth 4.

Clinical Outcomes

• Studies have shown that TXA reduces bleeding-related mortality in women with PPH, especially when administered shortly after delivery 2, 5.
• TXA has also been shown to reduce blood loss in women at high risk of postpartum hemorrhage undergoing cesarean delivery 6.