Approximately 100,000 women a year die around the world from blood loss associated with childbirth. It's widely available - some reports say that it costs about Rs 180 per vial in India - and can reduce maternal deaths due to postpartum haemorrhage when it's given within three hours of the onset of the bleeding. These findings provide the first comprehensive evidence on using tranexamic acid for post-partum haemorrhage and suggest it should be used as a frontline treatment. The research team filmed an interview with Utako in Japan before her death, aged 98, last year.
"This is the first time we've shown that tranexamic acid can save the lives of mothers from postpartum hemorrhage", Haleema Shakur, project director on the trial and associate professor of clinical trials at the London School of Hygiene & Tropical Medicine, said in an interview with Humanosphere.
Indian institutions had initially meant to participate in the trial but pulled out because of regulatory hurdles, she said. "But it looks like tranexamic acid has the potential to save lives". Gynaecologists also use it to treat excessive menstrual bleeding.
And so tranexamic acid has gone largely unused in maternity wards for decades.
In the trial, tranexamic acid was given via a drip.
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Moreover, timing played a key role in risk reduction: Women in the tranexamic acid group who received the drug within 3 hours after birth cut their risk of death due to bleeding by nearly a third compared with the placebo group (RR 0.69, 95% CI 0.52-0.91, P=0.008), though there was no difference when treatment was received more than 3 hours later, the authors wrote online in The Lancet.
As TXA works by stopping blood clots from breaking down, the researchers also found that it reduced the need for urgent surgery to control bleeding by more than a third.
"These are very significant results for India - post-partum bleeding is among the most common causes of maternal mortality", said Rishma Dhillon-Pai, a Mumbai gynaecologist and president of the Federation of Obstetrics and Gynaecological Societies of India (FOGSI), an apex body with a membership of about 34,000 gynaecologists.
Gynaecologists say post-partum bleeding is an acute event that can not be predicted. Around 100,000 women die each year from the complication. Pai said FOGSI is likely to use workshops to promote the use of tranexamic acid. It's affordable and widely available, but it hadn't been tested thoroughly.
The drug even helped women when doctors used it along with other common medications, such as oxytocin, says Margaret Kruk, a global health researcher at Harvard University. "But she could not convince doctors to do the necessary trials - our trial fulfills her dream", Shakur-Still said.
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