A Review of Guidelines for the Use of Tranexamic Acid in the Management of Postpartum Hemorrhage and Assessment of Associated Maternal Outcomes.
- 1School of Medicine, St. George's University, St. George's, GRD.
- 2School of Medicine, Hofstra University/Donald and Barbara Zucker, Hempstead, USA.
- 3Department of Pediatric Hematology Oncology, Cohen Children's Medical Center, New Hyde Park, USA.
Abstract
Postpartum hemorrhage (PPH) remains a major cause of maternal morbidity and mortality worldwide, requiring rapid recognition and coordinated hemostatic intervention. Tranexamic acid (trans-4-aminomethylcyclohexane-1-carboxylic acid; TXA), an antifibrinolytic agent that inhibits plasminogen-mediated fibrin degradation, has emerged as an important component of PPH management. Despite growing evidence supporting TXA, recommendations on its timing and placement within PPH treatment algorithms vary across major international guidelines. This narrative review examines the pharmacology, clinical indications, safety profile, and therapeutic role of TXA in PPH. It evaluates evidence supporting TXA in obstetric and non-obstetric hemorrhage, compares its role with other hemostatic therapies, and critically examines recommendations from major international and national organizations. It pays particular attention to differences in how these guidelines position TXA within PPH treatment pathways and integrate it with other first-response interventions. This review also considers uncertainties around prophylactic use, alternative hemostatic therapies, and variation in guideline implementation. Greater consistency in evidence-based recommendations may clarify TXA's role in contemporary PPH management while allowing flexibility for differences in healthcare settings and resources.
Related
- Efficacy of prophylactic tranexamic acid in preventing postpartum hemorrhage following repeat cesarean sections: a retrospective matched-cohort study
- Prevention and management of postpartum hemorrhage and hypertensive disorders of pregnancy: results from a 31-country rapid assessment
- Simulation-based education improves postpartum hemorrhage management knowledge and skills: a randomized controlled trial
- Fibrinogen Deficiency and Dysfunction in Postpartum Hemorrhage: Evidence, Thresholds, and Management Across Resource Settings
- Manual external uterine compression for postpartum hemorrhage after vaginal delivery: a prospective cohort study
BibTeX
@article{shekhawat2026review,
title = {{A Review of Guidelines for the Use of Tranexamic Acid in the Management of Postpartum Hemorrhage and Assessment of Associated Maternal Outcomes.}},
author = {Khushi Shekhawat and Akanksha Ahuja and Ranya Parekh and Arun Nair},
journal = {Cureus},
year = {2026},
month = sep,
doi = {10.7759/cureus.116511},
url = {https://europepmc.org/article/MED/42898296},
note = {CC BY},
}
RIS
TY - JOUR
TI - A Review of Guidelines for the Use of Tranexamic Acid in the Management of Postpartum Hemorrhage and Assessment of Associated Maternal Outcomes.
AU - Khushi Shekhawat
AU - Akanksha Ahuja
AU - Ranya Parekh
AU - Arun Nair
PY - 2026
DA - 2026/09/18
JO - Cureus
DO - 10.7759/cureus.116511
UR - https://europepmc.org/article/MED/42898296
AB - Postpartum hemorrhage (PPH) remains a major cause of maternal morbidity and mortality worldwide, requiring rapid recognition and coordinated hemostatic intervention. Tranexamic acid (trans-4-aminomethylcyclohexane-1-carboxylic acid; TXA), an antifibrinolytic agent that inhibits plasminogen-mediated fibrin degradation, has emerged as an important component of PPH management. Despite growing evidence supporting TXA, recommendations on its timing and placement within PPH treatment algorithms vary across major international guidelines. This narrative review examines the pharmacology, clinical indications, safety profile, and therapeutic role of TXA in PPH. It evaluates evidence supporting TXA in obstetric and non-obstetric hemorrhage, compares its role with other hemostatic therapies, and critically examines recommendations from major international and national organizations. It pays particular attention to differences in how these guidelines position TXA within PPH treatment pathways and integrate it with other first-response interventions. This review also considers uncertainties around prophylactic use, alternative hemostatic therapies, and variation in guideline implementation. Greater consistency in evidence-based recommendations may clarify TXA's role in contemporary PPH management while allowing flexibility for differences in healthcare settings and resources.
SN - 2168-8184
ER -