POSTPARTUM HEMORRHAGE MANAGEMENT WITH TRANEXAMIC ACID: A MULTICENTER ANALYSIS OF CLINICAL OUTCOMES AND SAFETY

Prof. Hiroshi Tanaka; MD; PhD; Dr. Yuki Sato; MD

Abstract

Postpartum hemorrhage (PPH) remains a leading cause of maternal morbidity and mortality globally, despite advancements in uterotonic therapies. This multicenter retrospective study evaluates the efficacy and safety of early tranexamic acid (TXA) administration in managing PPH across diverse clinical settings. By analyzing data from 984 patients who experienced blood loss exceeding 500 mL following vaginal delivery or 1000 mL following cesarean section, we investigated the impact of TXA on surgical intervention rates, blood transfusion requirements, and overall maternal outcomes. Patients were categorized based on whether they received TXA within three hours of birth alongside standard care. Our findings demonstrate that TXA significantly reduces the necessity for invasive surgical interventions and the volume of blood products required. Furthermore, the study addresses safety concerns, specifically regarding thromboembolic events, providing a comprehensive overview of the benefit-to-risk ratio. These results contribute to a robust evidence base supporting the integration of TXA into standardized PPH protocols, emphasizing the critical importance of timely administration to optimize maternal reproductive health outcomes. This research highlights the potential for TXA to serve as a cornerstone in reducing the global burden of obstetric hemorrhage.

Keywords: Postpartum Hemorrhage, Tranexamic Acid, Maternal Mortality, Obstetric Care, Antifibrinolytics, Blood Transfusion, Maternal Morbidity, Clinical Protocols

Postpartum hemorrhage is responsible for approximately 27% of maternal deaths globally, yet many of these fatalities are preventable with timely pharmacological intervention. The relevance of this study lies in its real-world multicenter application, bridging the gap between controlled clinical trials and routine obstetric practice. As healthcare systems strive to meet the Sustainable Development Goals for maternal health, identifying cost-effective and accessible treatments like tranexamic acid is paramount. This research provides clinicians and policymakers with regionalized evidence on the utility of antifibrinolytics in stabilizing patients during the 'golden hour' of hemorrhage. Furthermore, by identifying the reduction in surgical morbidity, this study supports the preservation of future fertility for mothers, aligning with the core objectives of reproductive health advocacy. The results offer a scalable model for PPH management that can be implemented in both low-resource and high-resource settings to improve maternal survival rates.

To evaluate the clinical efficacy of early tranexamic acid administration in reducing surgical interventions and transfusion requirements among women experiencing postpartum hemorrhage in a multicenter cohort.

This retrospective multicenter cohort study analyzed 984 cases of documented postpartum hemorrhage (PPH) across six tertiary obstetric units between 2020 and 2023. Inclusion criteria comprised women aged 18–45 with blood loss >500 mL (vaginal delivery) or >1000 mL (cesarean section). Patients were stratified into two groups: the TXA group (n=462), receiving 1g of intravenous tranexamic acid within 3 hours of delivery, and the Control group (n=522), receiving standard uterotonic therapy alone. Data were extracted from electronic health records, focusing on total blood loss, transfusion units, and secondary surgical interventions (uterine artery embolization, B-Lynch sutures, or hysterectomy). Statistical analysis was performed using Pearson’s chi-squared test for categorical variables and independent t-tests for continuous data. Multivariate logistic regression was utilized to calculate adjusted odds ratios (aOR) for surgical intervention, adjusting for maternal age, parity, and mode of delivery. A p-value of <0.05 was considered statistically significant.

The TXA group exhibited a significantly lower mean total blood loss compared to the control group (840 ± 210 mL vs. 1150 ± 340 mL, p<0.001). Administration of TXA was associated with a 38% reduction in the risk of requiring blood transfusions ≥2 units (OR 0.62; 95% CI 0.48–0.81). Most notably, the requirement for invasive surgical interventions to control bleeding was significantly reduced in the TXA cohort (4.3% vs. 9.8%, p=0.002). Adjusted logistic regression indicated that TXA treatment was an independent predictor for avoiding hysterectomy (aOR 0.35; 95% CI 0.19–0.64). Maternal mortality was lower in the TXA group (0.2% vs. 0.8%), though this did not reach statistical significance (p=0.18). Regarding safety parameters, the incidence of venous thromboembolic events (VTE) was 0.4% in the TXA group and 0.3% in the control group (p=0.82), indicating no significant increase in thrombotic risk associated with treatment.

The findings of this multicenter analysis provide strong evidence that the early administration of tranexamic acid is a highly effective adjunct therapy for postpartum hemorrhage. By significantly reducing the need for laparotomy and the volume of packed red blood cell transfusions, TXA preserves maternal physical integrity and reduces the strain on healthcare resources. The absence of a significant increase in venous thromboembolism suggests a favorable safety profile when administered within the narrow therapeutic window. We conclude that TXA should be systematically integrated into PPH emergency kits globally. Future research should focus on optimizing the dosage for high-risk populations and evaluating long-term reproductive outcomes. This study reinforces the AAMS commitment to evidence-based practices that decrease maternal mortality and improve the standard of obstetric care worldwide.