What it is: An anti-fibrinolytic agent that competitively inhibits activation of plasminogen to plasmin. Plasmin activation is inhibited, which reduces fibrin clot degradation by plasmin.
Indications: Post-partum hemorrhage of any etiology
Where to get it: Red trauma anesthesia med trays in trauma anesthesia cart in OB OR B; Omnicell in H22; Inpatient pharmacy
How to Administer TXA for PPH:
- Prophylaxis of PPH
- Administer IV over 30-60 sec during the 3 min after birth(s), after the oxytocin is initiated and the cord(s) is clamped.
- Treatment of PPH
- Administer IV over 10 min.
- Repeat after 30 minutes if blood loss is ongoing.
Infusion Trigger:
- At clinical discretion during a high blood loss case or case with PPH risk factors
- Consider use at the time you initiate transfusion of a third unit of product (including PRBC, plasma, cryoprecipitate)
Exclusion Criteria: Allergy to TXA
Inclusion Criteria: Post-partum hemorrhage of any etiology
REFERENCES:
- WOMAN Trial Collaborators. 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 May 27;389(10084):2105-2116.
- Shakur H et al. Antifibrinolytic drugs for treating primary postpartum haemorrhage. Cochrane Database Syst Rev. 2018 Feb 20;2:CD012964.
- Brenner A et al. The impact of early outcome events on the effect of tranexamic acid in post-partum haemorrhage: an exploratory subgroup analysis of the WOMAN trial. BMC Pregnancy Childbirth. 2018 Jun 7;18(1):215.
- Sentilhes et al. Tranexamic Acid for the Prevention of Blood Loss after Cesarean Delivery. NEJM. 2021 Apr 384(17):1623-34.