TXA Central is a resource for health professionals caring for patients with acute severe bleeding
Every year about 14 million women around the world suffer from postpartum haemorrhage (PPH) after giving birth and about 100,000 of them will die
Imagine, about every six minutes, a woman giving birth will bleed to death
Finding better ways to save the lives of women suffering PPH is critical
Tranexamic Acid (TXA) for PPH
The WOMAN Trial evaluated the effect of TXA on death, hysterectomy and other surgical interventions, and thromboembolic events in women with clinically diagnosed PPH.
A total of 20,060 women from 21 countries and 193 sites with PPH were randomly allocated to receive TXA (1g intravenously) or matching placebo in addition to usual care. If bleeding continued, a second dose of 1g was given.
Death due to bleeding was significantly reduced with TXA (relative risk = 0·81, 95% CI0·65–1·00, p = 0·045), particularly in women treated within 3 hours of giving birth (relative risk = 0·69, 95% CI 0·52–0·91, p=0·008).
The WOMAN trial showed that if given within 3 hours, TXA can reduce the risk of death due to bleeding by one-third and the need for surgery to stop bleeding by over one-third.
However, for many women, the treatment of PPH is too late to prevent death. Over one-third of pregnant women in the world are anaemic and many are severely anaemic. These women have an increased risk of PPH and suffer more severe outcomes if PPH occurs.
There is an urgent need to identify a safe and effective way to reduce postpartum bleeding in anaemic women. The WOMAN-2 trial investigates if we can use TXA to prevent PPH from happening in the first place.
Click on watch, read or teach to access videos, publications, and training materials
WOMAN Trial: Her Life Matters Trailer 1
WOMAN Trial: Her Life Matters Trailer 2
WOMAN Trial: Results Video
WOMAN Trial: BBC News Africa
Interview discussion on the WOMAN Trial results
WOMAN Trial: TXA for the Treatment of PPH
WOMAN Trial: Can we prevent women dying after childbirth?
WOMAN Trial: ‘The Blood Clock’ Art Installation
WOMAN Trial Procedure
WOMAN Trial: Teaser 1
WOMAN Trial: Teaser 2
WOMAN Trial: Teaser 3
WOMAN Trial: Nigeria
Nigerian doctors, midwives, patients and families share their experience of postpartum haemorrhage (PPH) and explain the heavy burden it weighs on the Nigerian population and health system.
WOMAN: Trial Results
WOMAN: Effect of treatment delay: a meta-analysis of 40,138 patients
WOMAN: World Health Organisation (WHO) recommendation on TXA for the treatment of PPH
Key recommendation: Administration of TXA should be considered as part of the first line PPH treatment and be administered as soon as possible after the onset of bleeding and within 3 hours of birth
WOMAN: What, who and when
Tranexamic acid for post-partum haemorrhage
WOMAN: Art for Maternal Health Awareness
WOMAN: BMC Pregnancy & Childbirth – Research Article
Anti-fibrinolytic agents in postpartum haemorrhage: a systematic review
WOMAN: Systematic Review
Does tranexamic acid prevent postpartum haemorrhage? A systematic review of randomised controlled trials
WOMAN: Anti-fibrinolytic Trials Collaboration
Effect of treatment delay on the effectiveness and safety of antifibrinolytics in acute severe haemorrhage: a meta-analysis of individual patient-level data from 40 138 bleeding patients
WOMAN: Clinical and contextual factors on LMIC’s PPH deaths
Clinical and contextual factors surrounding the deaths of 483 women following post-partum haemorrhage in developing countries
WOMAN: Analysis of the CRASH-2 and WOMAN trials
Risk factors for blood transfusion in traumatic and postpartum hemorrhage patient
WOMAN: Exploratory Subgroup Analysis
The impact of early outcome events on the effect of tranexamic acid in post-partum haemorrhage: an exploratory subgroup analysis of the WOMAN trial
Haematological and fibrinolytic status of Nigerian women with post-partum haemorrhage
WOMAN: Peripartum Hysterectomy Risk
Risk factors for peripartum hysterectomy among women with postpartum haemorrhage: analysis of data from the WOMAN trial
WOMAN: A Global Issue
Post-partum haemorrhage and tranexamic acid: a global issue
WOMAN: Finding Better Ways to Prevent Postpartum Hemorrhage
WOMAN: WOMAN-ETAC Trial
Effect of tranexamic acid on coagulation and fibrinolysis in women with postpartum haemorrhage (WOMAN-ETAC): a single-centre, randomised, double-blind, placebo-controlled trial
WOMAN: ETAPlaT trial sub-study
Effects of tranexamic acid on platelet function and thrombin generation (ETAPlaT): WOMAN trial sub-study
WOMAN Trial: Results Presentation
The WOMAN trial showed that TXA can reduce the number of women bleeding to death after childbirth by more than 30%
WOMAN Trial: Protocol
Study protocol The WOMAN Trial (World Maternal Antifibrinolytic Trial): tranexamic acid for the treatment of postpartum haemorrhage: an international randomised, double-blind placebo-controlled trial
WOMAN Trial: Statistical Analysis Plan
The effect of tranexamic acid on the risk of death and hysterectomy in women with post-partum haemorrhage: statistical analysis plan for the WOMAN trial
TXAcentral is a resource for health professionals caring for people with acute bleeding
TXAcentral brings together randomised trial evidence on the effectiveness and safety of tranexamic acid
Data on many of the trials are also available at the freeBIRD website
Postpartum Haemorrhage (PPH) is the leading cause of maternal death worldwide, responsible for around 100 000 deaths each year. TXA given as quickly as possible after birth and no later than 3 hours, reduces death due to bleeding and the need for surgery to stop bleeding
Every year there are over 300 million surgical procedures worldwide. Bleeding is an important complication and many patients require a blood transfusion. TXA reduces blood loss in surgical patients by about one‐third. However, the effects of TXA on thromboembolic events and mortality in surgery are uncertain