Immediate treatment with a cheap and widely available clot-stabilising drug could save the lives of thousands of people each year, including women with severe bleeding after childbirth, a study has found.
A meta-analysis of more than 40,000 patients found that the likelihood of death due to blood loss was reduced by more than 70% if tranexamic acid was administered straight after injury or birth.
But the effectiveness of the drug – available over the counter in the UK to women suffering from heavy periods – diminished over time. The chances of survival fell by 10% for each 15-minute delay, with no benefit seen when administered after three hours.
Postpartum haemorrhage (excessive bleeding after childbirth) is the leading cause of maternal death worldwide, killing about 100,000 women a year, mostly in low- and middle-income countries. More than 2 million people worldwide die from traumatic extracranial bleeding, often as a result of road traffic injuries and violence.
Prof Ian Roberts from the London School of Hygiene and Tropical Medicine, who initiated the study, said: “Responding quickly can be the difference between life and death and that means patients must be treated urgently at the scene of injury or as soon as the diagnosis of haemorrhage is made. We have to make sure tranexamic acid is available before patients reach hospital and whenever a woman gives birth.”
Antifibrinolytic drugs work by stopping blood clots from breaking down and reducing bleeding. They have been used for many years to reduce heavy menstrual bleeding and are often given during surgery to reduce the need for blood transfusions.
For the meta-analysis, published in the Lancet on Tuesday, the authors identified a total of 13 tranexamic acid trials conducted between 1946 and 2017 – but only two assessed the impact of treatment time on its effectiveness.
Their analysis showed that almost two-thirds of bleeding deaths occurred within 12 hours of onset (884 of 1,408 bleeding deaths). Deaths due to postpartum haemorrhage peaked two to three hours after childbirth.
Survival from severe bleeding increased by a fifth with the use of tranexamic acid compared with placebo, irrespective of the site of bleeding. Only 1.5% of women given tranexamic acid died of bleeding versus 1.9% of women given placebo plus standard care, and 4.9% of trauma patients given tranexamic acid died of bleeding compared with 5.7% given placebo and standard care.
The researchers took age and systolic blood pressure into account. They found no evidence of complications or increased risk of clotting (ie heart attack, stroke, pulmonary embolism, and deep vein thrombosis) compared with placebo, and fewer cases of heart attacks were noted with tranexamic acid, which is also used as a skin whitener in Japan and the far east.
The study builds on previous research which showed that tranexamic acid cut deaths due to postpartum haemorrhage and bleeding after serious injury by about a third if given within three hours of the onset of bleeding.
Roberts said: “Tranexamic acid is safe, cheap, easily administered, and does not need to be refrigerated. Most haemorrhage deaths occur within hours of bleeding onset. Prompt treatment has the potential to save thousands of additional lives worldwide every year.
“Given the importance of early treatment, time from bleeding onset to early treatment should be audited and communicated to healthcare professionals. Establishing national or regional quality improvement initiatives, with best practice benchmarking of time to treatment, might improve survival.”
He said more research was needed to understand the mechanism of the treatment.
