Tranexamic Acid
Post-Partum Hemorrhage
The WOMAN trial (Link) shows that the early administration of TXA decreases mortality due to hemorrhage without increasing the risk of thrombotic events. However, all-cause mortality was not impacted, no differences in the rates of hysterectomy. Summary: TXA is safe in PPH, but not clearly effective.
Non-traumatic ICH
- TICH-2 (2018) studied IV TXA in patients with non-traumatic ICH. There were no differences in mortality, functional outcomes at 3 months, barely any differences in hematoma size.
- ULTRA (2021) studied IV TXA at the initial diagnosis of SAH, and there was no difference in the outcome of good neurologic outcome, nor any of the secondary outcomes.
Trauma
CRASH-2 demonstrated that TXA reduces all cause death at 4 weeks in trauma patients (Absolute Risk Reduction 1.5%). A subgroup analysis demonstrated a 0.8% ARR reduction in death secondary to bleeding with TXA
Epistaxis
NoPAC (2021) shows that topical TXA in addition to topical vasoconstrictor alone, does NOT decrease the need for anterior nasal packing, LOS, recurrent epistaxis, blood transfusion requirement.
Gastrointestinal Bleeding
HALT-IT