Effect of Early Tranexamic Acid on Death, Hysterectomy, and Other Morbidities in Women with Post-partum Haemorrhage: An International, Randomised, Double-Blind, Placebo-Controlled Trial
Lancet, 2017 · International, randomized, double-blind, placebo-controlled trial
Clinical question
Does early intravenous tranexamic acid reduce mortality and hysterectomy in postpartum hemorrhage?
What the trial found
Early administration of tranexamic acid within 3 hours of delivery significantly reduces maternal death from postpartum hemorrhage without increasing adverse thromboembolic complications.
Current guideline position
Current WHO/FIGO/ICM postpartum-hemorrhage guidance recommends IV tranexamic acid as early as possible and within 3 hours of birth for women with clinically diagnosed postpartum hemorrhage, as part of standard first-response treatment unless contraindicated.
Clinical interpretation
Establishes early TXA (1 g IV) as an essential component of obstetric massive hemorrhage resuscitation protocols.
Maternal physiology, preeclampsia/eclampsia, HELLP vs AFLP, postpartum hemorrhage (MTP/TXA), peripartum cardiomyopathy, and arrest.
The trauma lethal diamond (hypothermia, acidosis, coagulopathy, hypocalcemia), 1:1:1 massive transfusion (PROPPR trial), early TXA (CRASH-2), and TEG/ROTEM algorithms.
Patient-specific RBC transfusion thresholds, current platelet/procedural thresholds, plasma/cryoprecipitate use, and the TRALI vs TACO diagnostic matrix.
Tissue-factor-driven coagulation activation, antithrombin/protein C depletion, PAI-1-associated fibrinolytic suppression, ISTH 2025 DIC assessment, comparison with TTP/HUS/HIT, and targeted replacement.