Tranexamic Acid (Obstetric — PPH)

How it works

It inhibits plasminogen activation to plasmin, stabilising fibrin clot and limiting fibrinolysis at the placental bed and other bleeding sites.

Prescribing in practice

• Early administration is critical, as benefit in postpartum haemorrhage falls markedly with delay, so it should be given as soon as possible after the onset of bleeding.
• It is an adjunct to, not a replacement for, mechanical, uterotonic and resuscitative measures in major obstetric haemorrhage.
• Caution applies with known thromboembolic disease, and rapid intravenous injection can cause hypotension.

Monitoring

Monitor ongoing blood loss, haemodynamic status and the response to the wider haemorrhage protocol rather than relying on the drug alone.

Counselling the patient

• This medicine is given by a vein during heavy bleeding after birth to help control it.
• It works alongside other treatments to stop the bleeding.
• The team will watch your blood pressure and bleeding closely after it is given.

Evidence & guidelines

The WOMAN trial showed tranexamic acid reduces death due to bleeding in postpartum haemorrhage when given early, and it is recommended in UK obstetric haemorrhage guidance.