Category: Obstetrics & Gynecology
Keywords: postpartum hemorrhage, TXA (PubMed Search)
Posted: 2/8/2025 by Jennifer Wang, MD
(Updated: 2/10/2025)
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In the last few months, there have been multiple articles published regarding the use of prophylactic TXA to prevent postpartum hemorrhage. While almost none of us want to ever be in the situation where we have to deliver a baby in the ED, we need to be prepared for all outcomes.
A meta-analysis by Ker et. al (Oct 2024) and a RCT, blinded study by Zhang et. al (Dec 2024) both demonstrated that giving 1g TXA immediately after delivery of a baby can reduce the rate of severe postpartum hemorrhage in patients with risk factors. These studies had a wide variety in what they considered risk factors, but a few that showed particular significance included: hx of postpartum hemorrhage, history of anemia, gestational diabetes, and placental adhesion.
So next time you've scooped that screaming baby out into your already chaotic emergency department, ask your patient (not the baby) a few questions about their birth history and think about giving 1g of TXA to prevent a horror show for whoever is coming on for you next.
Caveat: These studies were done in delivery rooms and not emergency rooms, but I think we can extrapolate since it would be very hard to find enough patients to conduct a study like this in the emergency department.
Ker K, Sentilhes L, Shakur-Still H, Madar H, Deneux-Tharaux C, Saade G, Pacheco LD, Ageron FX, Mansukhani R, Balogun E, Brenner A, Prowse D, Arribas M, Ahmadzia H, Chaudhri R, Olayemi O, Roberts I; Anti-fibrinolytics Trialists Collaborators Obstetric Group. Tranexamic acid for postpartum bleeding: a systematic review and individual patient data meta-analysis of randomised controlled trials. Lancet. 2024 Oct 26;404(10463):1657-1667. doi: 10.1016/S0140-6736(24)02102-0. PMID: 39461793.
Zhang P, Jia YJ, Lv Y, Fan YF, Geng H, Zhao Y, Song H, Cui HY, Chen X. Effects of tranexamic acid preconditioning on the incidence of postpartum haemorrhage in vaginal deliveries with identified risk factors in China: a prospective, randomized, open-label, blinded endpoint trial. Ann Med. 2024 Dec;56(1):2389302. doi: 10.1080/07853890.2024.2389302. Epub 2024 Aug 12. PMID: 39129492; PMCID: PMC11321115.
