This randomised controlled trial of tranexamic acid versus placebo in over 4,000 women after vaginal delivery was clearly expecting a reduction in the rate of postpartum haemorrhage (defined by blood loss > 500 mL). Although there was a reduction, it was not statistically significant. The clinicians felt there was less bleeding and less uterotonics were used.

What have we learnt? I am reminded that there is very little literature looking at the fibrinolytic status of women post delivery, but the available data shows they are in fibrinolytic shutdown. Fibrinolysis is probably only stimulated when there is bleeding. So shouldn’t we learn more about the fibrinolytic changes post delivery and use this to inform future clinical trials?

Ending on a positive note, once again we learn how safe tranexamic acid is – no increased rates of thrombosis and only a slightly higher rate of nausea and vomiting.

– Beverley J. Hunt