Administration of tranexamic acid, an antifibrinolytic drug, has been shown to reduce bleeding in trauma and surgery patients. The results of the WOMAN (World Maternal Antifibrinolytic) trial recently published in The Lancet show that tranexamic acid also reduces the risk of maternal death due to bleeding. Between 2010 and 2016, over 20,000 women with post-partum hemorrhage in 21 countries were randomly assigned to intravenously receive either tranexamic acid (n=10,051) or placebo (n=10,009) in addition to standard care. Although the risk of death due to bleeding was reduced from 1.9% in the placebo group to 1.5% for all women who received tranexamic acid (risk ratio, 0.81 [95% CI, 0.65-1.00]; p=0.05), the relative effect of the drug in reducing the risk of death was even greater when administered within 3 hours of birth (1.2% of women died in the tranexamic acid group vs 1.7% in the placebo group; risk ratio, 0.69 [95% CI, 0.52-0.91]; p=0.008). There was no difference in mortality by trial arm among women administered treatment 3 hours after birth, highlighting the importance of early administration.
- Collaborators WT. 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. Lancet 2017.