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 Collaborators. Lancet 2017; Published Online April 26, 2017 http://dx.doi.org/10.1016/ S0140-6736(17)30638-4

Clinical Question

• Does the early administration of tranexamic acid (TXA), compared with placebo, reduce death from bleeding in women with post-partum haemorrhage (PPH)?

N = 20060, 193 hospitals in 23 countries

Authors’ Conclusions

• 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

The Bottom Line

• Tranexamic acid may be beneficial in reducing the risk of death due to post-partum haemorrhage. The study has some significant methodological limitations, including a change in power calculation and hypothesis after it was commenced, as well as a low fragility index.
• On the basis of it being cheap with a good safety profile in this study, consider giving tranexamic early in post-partum haemorrhage. Early resuscitation, management of coagulopathy and surgical assistance with source control, are the most important interventions