title: High-dose tranexamic acid reduces blood loss in postpartum haemorrhage.
abstract: BACKGROUND
  Our purpose in conducting this study was to determine whether administration of high-dose tranexamic acid (TA) at the time of diagnosis of postpartum haemorrhage (PPH) could reduce blood loss.
  
  
  METHODS
  This was a randomised, controlled, multicentred, open-label trial. Women with PPH >800 mL following vaginal delivery were randomly assigned to receive TA (loading dose 4 g over 1 hour, then infusion of 1 g/hour over 6 hours) or not. In both groups, packed red blood cells (PRBCs) and colloids could be used according to French guidelines. The use of additional procoagulant treatments was permitted only in cases involving intractable bleeding. The primary objective was to assess the efficacy of TA in the reduction of blood loss in women with PPH, and the secondary objectives were the effect of TA on PPH duration, anaemia, transfusion and the need for invasive procedures.
  
  
  RESULTS
  A total of 144 women fully completed the protocol (72 in each group). Blood loss between enrolment and 6 hours later was significantly lower in the TA group than in the control group (median, 173 mL; first to third quartiles, 59 to 377) than in controls (221 mL; first to third quartiles 105 to 564) (P = 0.041). In the TA group, bleeding duration was shorter and progression to severe PPH and PRBC transfusion was less frequent than in controls (P < 0.03). Invasive procedures were performed in four women in the TA group and in seven controls (P = NS). PPH stopped after only uterotonics and PRBC transfusion in 93% of women in the TA group versus 79% of controls (P = 0.016). Mild, transient adverse manifestations occurred more often in the TA group than in the control group (P = 0.03).
  
  
  CONCLUSIONS
  This study is the first to demonstrate that high-dose TA can reduce blood loss and maternal morbidity in women with PPH. Although the study was not adequately powered to address safety issues, the observed side effects were mild and transient. A larger international study is needed to investigate whether TA can decrease the need for invasive procedures and reduce maternal morbidity in women with PPH.
  
  
  BACKGROUND
  Controlled Trials ISRCTN09968140.
authors.affiliation: Pole d'Anesthésie-Réanimation, CHU Lille, 2 avenue Oscar Lambret, Lille F-59037, France. anne-sophie.ducloy@chru-lille.fr
authors.forename: Anne-Sophie
authors.initials: AS
authors.lastname: Ducloy-Bouthors
authors.forename: Brigitte
authors.initials: B
authors.lastname: Jude
authors.forename: Alain
authors.initials: A
authors.lastname: Duhamel
authors.forename: Françoise
authors.initials: F
authors.lastname: Broisin
authors.forename: Cyril
authors.initials: C
authors.lastname: Huissoud
authors.forename: Hawa
authors.initials: H
authors.lastname: Keita-Meyer
authors.forename: Laurent
authors.initials: L
authors.lastname: Mandelbrot
authors.forename: Nadia
authors.initials: N
authors.lastname: Tillouche
authors.forename: Sylvie
authors.initials: S
authors.lastname: Fontaine
authors.forename: Françoise
authors.initials: F
authors.lastname: Le Goueff
authors.forename: Sandrine
authors.initials: S
authors.lastname: Depret-Mosser
authors.forename: Benoit
authors.initials: B
authors.lastname: Vallet
authors.forename: Sophie
authors.initials: S
authors.lastname: Susen
mesh_terms: D000328:Adult; D000933:Antifibrinolytic Agents / Q000008:administration & dosage*; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D007275:Injections, Intravenous; D006473:Postpartum Hemorrhage / Q000188:drug therapy*; D011247:Pregnancy; D011446:Prospective Studies; D014148:Tranexamic Acid / Q000008:administration & dosage*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000933:Antifibrinolytic Agents; D014148:Tranexamic Acid