Tranexamic acid for post-partum haemorrhage in the WOMAN trial

Letson, Hayley L.;Dobson, Geoffrey P.

Abstract

[Extract] We read with interest the WOMAN trial (May 27, p 2105).1 Tranexamic acid is an antifibrinolytic drug used to reduce haemorrhage complications in trauma and elective surgery. The WOMAN trial originally planned to enrol 15 000 women with a composite primary endpoint of death from all causes or hysterectomy within 42 days of giving birth. The trial increased the number of participants to more than 20 000 “in the hope that the trial would have enough power to detect a reduction in post-partum haemorrhage death”.1 This study reported that tranexamic acid significantly reduced the risk of death from bleeding from 191 deaths (1·9%) to 155 deaths (1·5%; p=0·045).1 Further reductions in death occurred when tranexamic acid was given within 3 h of giving birth (1·7% vs 1·2%; p=0·008). Reduction in mortality from all causes was not significantly different between the tranexamic acid group and the placebo group (p=0·16). The WOMAN Trial Collaborators concluded that “when used as a treatment for post-partum haemorrhage, tranexamic acid should be given as soon as possible after bleeding onset”.

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390

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1474-547X

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10102

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Elsevier

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DOI

10.1016/S0140-6736(17)31947-5