It begins in Tokyo - History of TXA, a drug which saves millions of mother lives from postpartum hemorrhage

It started with a Japanese wife and husband team in Tokyo in the 1950s. Postpartum hemorrhage was a leading cause of maternal death in Japan at the time, and Utako and Shosuke Okamoto set out to identify a drug that could reduce the number of mothers dying during childbirth. Resources were hard to find at the time, especially for something like blood research. On top of that, the heavily male-dominated medical field meant that Utako had to work twice as hard and long for the chance to even be acknowledged for her accomplishments. After giving birth, she had to bring her baby into the lab because the system did not support working mothers.

Their hard work paid off. They knew that there was already an enzyme in the blood that broke down clots - they just needed to figure out how to get that enzyme going. The amino acid lysine was found to be effective, but they kept looking, thinking there must be more. In 1962, they published in the Keio Journal of Medicine about a drug called tranexamic acid (TXA), which they discovered to be 27 times more powerful than a previous lysine-based drug. Despite this, local obstetricians were not too interested and tranexamic acid was eventually marketed to easy heavy menstrual bleeding and bleeding from procedures such as tooth extractions.

Years later, research finally recognized the full extent of what TXA could do for trauma patients. In 2010, results of the CRASH-2 trial was published in the Lancet. Researchers found that out of over 10,000 study participants, TXA significantly reduced the risk of death due to bleeding. Earlier this year, the WOMAN trial focused specifically on pregnant women and found that TXA significantly reduced death due to postpartum hemorrhage as well. Utako passed away shortly after recruiting for the WOMAN study reached its goal of 20,000 participants, but she said she already knew the results. “I am absolutely sure that it’s going to be effective - I don’t need the research to know this.”

By Vivian Shih