E-DRUG: Tranexamic acid IV inj can reduce PPH deaths by 31% if given in 3h after birth
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Dear E-druggers,
Tranexamic acid injection can reduce post-partum haemorrhage deaths
by 31% if given IV in 3h after birth
Tranexamic acid (TXA) is an antifibrinolytic that competitively inhibits the
activation of plasminogen to plasmin. Tranexamic acid is a competitive
inhibitor of plasminogen activation, and at much higher concentrations, a
non-competitive inhibitor of plasmin, i.e., actions similar to aminocaproic
acid. (Source: Tranexamic Acid - DrugBank;
https://www.drugbank.ca/drugs/DB00302)
A systematic review and meta-analysis found in 2014 that 'although
tranexamic acid administration seemed to significantly reduce blood loss and
the incidence of severe post-partum haemorrhage, further prospective trials
are needed to confirm the efficacy and safety of tranexamic administration
in the treatment of postpartum haemorrhage. Those studies should assess the
pharmacokinetic profile and the safety of this drug in pregnant womene'.
(http://dx.doi.org/10.1016/j.annfar.2014.07.748)
The latest Lancet reports on the WOMAN trial which tested the effect of
tranexamic acid on post-partum haemorrhage; see the open access paper at
http://dx.doi.org/10.1016/S0140-6736(17)30638-4 and the editorial at
https://doi-org.eur.idm.oclc.org/10.1016/S0140-6736(17)31111-X
Deaths from bleeding were significantly reduced by 19% with the use of
tranexamic acid injection. Maternal mortality was even reduced by 31% if
tranexamic acid was given within 3 h of birth.
The conclusion of the WOMAN Trial Collaborators: e'Tranexamic acid reduces
death due to bleeding in women with post-partum haemorrhage with no adverse
effects. When used as a treatment for post-partum haemorrhage, tranexamic
acid should be given as soon as possible after bleeding onset.e'
The investigators acknowledge that in many settings where most maternal
deaths take place-at home or in very poorly resourced facilities-intravenous
administration of tranexamic acid may not be possible. They urge further
studies of tranexamic acid given by other routes.
TXA has also been tested for trauma patients (CRASH-2 trial,
doi:10.1371/journal.pone.0018987): Early administration of TXA to bleeding
trauma patients is likely to be highly cost effective in low, middle and
high income settings. The authors estimated that the widespread use of TXA
could save between 70,000 and 100,000 lives per year around the world.
Because over 90% of trauma deaths are in low and middle income countries the
potential for TXA to save lives is particularly high in these settings.
Nevertheless, TXA is unavailable in many low and middle income countries.
Tranexamic acid Injection is on the WHO Model Essential Drugs List with a
100 mg/ mL in 10e mL ampoule.
The MSH international benchmark price indicator guide (http://mshpriceguide.
org) has no data on sellers, and only a few entries from buyers (Peru
bought it for USD 2.36/ampoule in 2013. The 2015 edition only lists South
Africa as a buyer for USD 5.60 per 5mL ampoule).
This probably indicates that this essential drug is underutilised.
Tranexamic acid also exists in 500mg tablets, which is proposed for treating
cyclic heavy menstrual bleeding.
Any experiences amongst E-druggers with this neglected essential medicine?
Regards
Wilbert
Wilbert Bannenberg, public health consultant
Founder and co-moderator of E-drug
"Wilbert Bannenberg" <wilbert.bannenberg@gmail.com>
E-DRUG@healthnet.org