Tranexamic Acid and Its Implications in the Treatment and Prevention of Postpartum Hemorrhage

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Santi Bunfoo
Patchareya Nivatpumin


The antifibrinolytic agent “tranexamic acid” has been widely studied for the treatment and prevention of perioperative bleeding in various operations. In 2017, a large randomized controlled trial, called the WOMAN (World Maternal Antifibrinolytic) Trial, reported that 1 g of tranexamic acid could decrease the mortality rate from hemorrhage after vaginal or cesarean delivery if administered within 3 hours after delivery without increasing the risk of thromboembolic events. Following systematic reviews and meta-analysis showed the same results. This therefore implies that tranexamic acid is the only medication that has been proven to decrease the death rate from postpartum hemorrhage. Nevertheless, there is insufficient data to recommend tranexamic acid to prevent postpartum hemorrhage after vaginal and cesarean delivery. The authors hereby review the mechanism, pharmacology, and effects of tranexamic acid and the utilization of this medication in treating and preventing postpartum hemorrhage. We provide up-to-date recommendations by the World Health Organization. However, there is still much to be learned about the dosage and outcomes of tranexamic acid toward multiple systems after treating or preventing postpartum hemorrhage.

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Review articles


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