TXA 50 years later - recommended by WHO for PPH treatment

Tranexamic acid (TXA) has been around since the 1960s, when a wife-and-husband research team from Japan discovered how powerful the drug could be for treating severe bleeding. As with many other great discoveries, it took some time before the scientific community and public took it seriously as a crucial, potentially lifesaving treatment for postpartum hemorrhage (PPH), the leading cause of maternal mortality.

PPH is defined as blood loss of more than 500mL after vaginal birth, more than 1,000mL after caesarean section, or any blood loss that leads to hemodynamic instability. It’s a major health problem, especially in low-income countries, but is fairly treatable and death is preventable with the right treatments given at the right times. Preventing death from PPH means reducing global inequalities in maternal health outcomes and reducing the burden on already struggling health systems. It means healthier moms, healthier babies, more productive lives, and numerous social and economic benefits to society.

The WHO in 2012 issued a conditional recommendation to use TXA when uterotronics fail to control bleeding or if the bleeding is believed to be because of trauma. However, in 2017, after the results from the large, randomized controlled WOMAN trial were published, the WHO updated some key recommendations regarding the use of TXA. Some main updates include:

• TXA should be considered part of the standard comprehensive PPH treatment package and for use in all cases of PPH

• TXA should be readily available at all times in delivery and postpartum areas of facilities providing emergency obstetric care

• TXA should be administered within 3 hours of birth. Benefits decrease by 10% every 15 minutes, and there appears to be no benefits after 3 hours.

Acknowledgement from the WHO and updates to its recommendations is certainly an important step, but policymakers, healthcare workers, community leaders, and many other stakeholders still have work to do to ensure that the introduction of TXA is successful. This includes working TXA into national policy, training healthcare workers to properly recognize PPH and administer TXA, and ensure proper monitoring and data availability so we can continue to research and improve treatment.

By Vivian Shih