# Does tranexamic acid help in postpartum haemorrhage?

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**Summary:** Early tranexamic acid reduces death due to bleeding in postpartum haemorrhage; benefit is time-critical (within 3 hours).

Tranexamic acid (TXA) reduces death due to bleeding in women with postpartum haemorrhage when given early. In the WOMAN trial (~20,000 women across 21 countries), TXA significantly reduced death due to bleeding, with no increase in adverse events including thromboembolism [1].

The benefit was greatest when TXA was given within 3 hours of birth; treatment given later showed no clear benefit, supporting early administration as soon as PPH is diagnosed [1]. TXA did not reduce hysterectomy, as the decision often preceded or accompanied treatment.

Overall all-cause mortality was not significantly reduced, and TXA is an adjunct to — not a replacement for — standard uterotonic and surgical management of PPH [1]. WHO and major obstetric bodies recommend early TXA in established PPH.

## Limitations

- Benefit is time-critical: efficacy is confined to administration within ~3 hours of birth.
- The trial showed reduced death from bleeding but not a significant reduction in overall mortality or hysterectomy.

## Sources

1. [IV / Randomised trial] Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial. The Lancet (2017). PMID 28456509. https://pubmed.ncbi.nlm.nih.gov/28456509/

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