Relative Risk: 0.81 (95% CI 0.65–1)
Absolute Event Rate: 1.5% vs 1.9%
Tranexamic acid is recommended as a safe and effective treatment for postpartum hemorrhage, abnormal uterine bleeding, and melasma, with a low risk of venous thromboembolism in appropriately selected patients.
Supports tranexamic acid for postpartum hemorrhage; confirms prior randomized evidence on efficacy and safety.
Key points• Tranexamic acid (TXA) reduces the risk of bleeding and, consequently, the risk of death from hemorrhage.• It is indicated for postpartum hemorrhage (PPH).• It is also recommended for abnormal uterine bleeding.• In general, TXA does not increase the risk of venous thromboembolism (VTE).• Patients using combined oral contraceptives, who are obese or have other known risk factors for thrombosis should be individually evaluated before using TXA. Recommendations• Tranexamic acid is an efficient and safe alternative in the treatment of dysfunctional uterine bleeding with a low risk of VTE.• Although it shows good results in the management of PPH, maintaining a low risk of VTE, the thromboembolic risk must be assessed in all postpartum women.• Tranexamic acid is effective in the prevention of PPH before cesarean sections in high-risk pregnancies.• It is indicated for gynecological surgeries with a high risk of bleeding or established hemorrhage, minimizing the significant increase in VTE risk.However, all surgical patients should undergo thromboembolic risk assessment.• Tranexamic acid is an option for the treatment of melasma, without increasing the risk of VTE.• The indication of TXA for patients known to have thrombophilia should be individualized. FEBRASGO POSITION STATEMENT Uses of tranexamic acid and the risk of thrombosis in womenNumber 11 -2025
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Barros et al. (2025) conducted a review in Bleeding conditions (postpartum hemorrhage, abnormal uterine bleeding). Tranexamic acid vs. Placebo or standard of care was evaluated on Death due to bleeding overall in postpartum hemorrhage (RR 0.81, 95% CI 0.65-1.00). Tranexamic acid reduces death due to bleeding by 19% (RR 0.81) in patients with postpartum hemorrhage and is generally safe for various gynecological bleeding conditions without significantly increasing the risk of venous thromboembolism.
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