From the Guidelines
For vaginal hemorrhage, tranexamic acid (TXA) should be administered at a dose of 1 gram intravenously over 10 minutes, which can be repeated after 30 minutes if bleeding continues, as recommended by the WHO based on the WOMAN trial 1. This recommendation is based on the strongest and most recent evidence, which prioritizes morbidity, mortality, and quality of life as the outcome. The WHO strongly recommends early use of intravenous tranexamic acid, in addition to standard care, for women with clinically diagnosed post-partum haemorrhage following vaginal birth or caesarean section 1. Some key points to consider when administering TXA include:
- Ensuring the patient doesn't have contraindications such as active thromboembolic disease, subarachnoid hemorrhage, or severe renal impairment
- Monitoring for potential side effects such as nausea, vomiting, or hypotension during administration
- Administering TXA as early as possible after the onset of bleeding, ideally within 3 hours, for optimal effectiveness
- Considering 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, as supported by the WOMAN trial and other studies 1. It's also important to note that the use of TXA has been shown to reduce maternal death due to hemorrhage in cases of postpartum hemorrhage, and its use is recommended by several authorities 1.
From the Research
Dosage of TXA for Vaginal Hemorrhage
- The WHO recommends that women with post-partum haemorrhage receive 1 g tranexamic acid intravenously as soon as possible after giving birth, followed by a second dose if bleeding continues after 30 min or restarts within 24 h since the first dose 2.
- Early administration of 1-2 g tranexamic acid is recommended, followed by an additional dose in cases of ongoing bleeding 3.
- The effect of tranexamic acid is greatest when women receive it within 3 h of childbirth, with no benefit when the drug is given more than 3 h after bleeding onset 2.
- Limited evidence suggests that prophylactic TXA reduces blood loss at the time of delivery and decreases transfusion rates in the obstetric population, with a recommended dosage of 1 g 4, 5.
Administration and Timing
- Tranexamic acid should be administered intravenously as soon as possible after giving birth 2.
- The use of tranexamic acid in addition to prophylactic oxytocin in women with vaginal delivery may decrease the incidence of postpartum hemorrhage, with a recommended dosage of 1 g 4.
- Viscoelastic hemostatic assays, such as thromboelastography and thromboelastometry, may provide a real-time continuum of coagulation and fibrinolysis when introduced as a supplement in transfusion management of postpartum hemorrhage 3.