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Antifibrinolytic Pregnancy: Used in postpartum — safe after delivery

Tranexamic Acid (Obstetric — PPH)

Brand names: Cyklokapron, Exacyl

Adult dose

Dose: PPH treatment: 1 g IV over 10 min. Repeat 1 g IV over 10 min if bleeding continues after 30 min or restarts. Give within 3 hours of birth.
Route: IV
Frequency: 1 g at diagnosis; repeat once if needed
Max: 2 g total IV
WOMAN trial (Lancet 2017): TXA 1 g IV reduces death from PPH by 19% if given within 3 hours of birth. Administer as early as possible. Standard oxytocin and surgical management proceed concurrently.

Paediatric dose

Route: N/A
Frequency: N/A
Max: N/A in obstetric context
Concentration: 100 mg/mL N/A/ml
Obstetric indication — not applicable in paediatrics

Dose adjustments

Renal

Reduce dose in renal impairment — accumulation risk

Hepatic

No dose adjustment required

Clinical pearls

  • WOMAN trial: largest RCT in obstetrics; TXA reduces PPH death by 19% when given within 3 hours — early administration is key
  • Time-sensitive: benefit decreases and is lost after 3 hours of bleeding
  • WHO 2017 recommendation: TXA given within 3 hours of delivery for all PPH (blood loss >500 mL vaginal or >1000 mL CS)
  • Also prophylactically used in elective CS (1 g IV at skin incision) — E-MOTIVE trial data supports prophylactic use

Contraindications

  • History of thromboembolic disease (relative)
  • Active thromboembolic disease
  • Haematuria of upper urinary tract origin (risk of ureteric clot obstruction)

Side effects

  • Nausea
  • Diarrhoea
  • Hypotension (if IV given too fast)
  • Visual disturbances (long-term high-dose — not relevant in acute use)
  • Thromboembolic events (rare in short courses)

Interactions

  • Procoagulant drugs — additive thrombotic risk (theoretical)

Monitoring

  • Blood loss estimation
  • Haemodynamic status (BP, HR)
  • Coagulation studies (if massive haemorrhage)
  • Response to treatment

Reference: BNFc; WOMAN Trial (Shakur et al, Lancet 2017); WHO PPH Management Guidelines 2022; RCOG Green-top 52. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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