This systematic review provides a good summary of trials evaluating tranexamic acid (TXA) for the prevention and treatment of postpartum haemorrhage (PPH). The authors identified 13 randomised controlled trials for PPH prevention after caesarean (n = 10) and vaginal (n = 2) delivery and for PPH treatment after vaginal delivery (n = 1). They conclude that, although TXA appears to be a promising drug for the prevention and treatment of PPH after both vaginal and caesarean delivery, the current level of evidence supporting its efficacy and safety in this clinical setting is insufficient.

The article is slightly inaccurate about the WOMAN study, which will recruit 20,000 women with PPH, not 15,000. And I disagree with the statement that selection bias is being applied in this trial because women with PPH “are eligible only if the clinician is uncertain as to whether or not to use TXA”. Isn’t that the point of a trial?

– Beverley J. Hunt