The role of tranexamic acid in obstetric hemorrhage: a narrative review

Abnormal postpartum hemorrhage is a common problem, complicating 3-5% of vaginal and operative deliveries. In a majority of cases (98%) uterine atony, retained placenta or genital tract lacerations are responsible for excessive blood loss. However, occasionally, serious coagulopathy may occur early after delivery or in specific circumstances such as with placental abruption. Also, when bleeding is caused by uterine atony, retained placenta or vaginal lacerations, a dilutional coagulopathy may develop. Hence correcting coagulation abnormalities is often required. Crucial to manage postpartum coagulopathy is the use of tranexamic acid to reduce hyperfibrinolysis. In the present narrative review, we will discuss the use of tranexamic acid for the prevention and management of major postpartum hemorrhage by reviewing the available literature.