Tranexamic Acid for Life‑Saving Indications

Post‑Partum Hemorrhage (PPH)

The World Health Organization strongly recommends early intravenous tranexamic acid (within 3 hours of birth) for all women with clinically diagnosed PPH after vaginal delivery or caesarean section, irrespective of cause. Strong recommendation based on high‑quality evidence. 1, 2, 3
Clinically diagnosed PPH is defined as blood loss > 500 mL after vaginal birth, > 1000 mL after caesarean section, or any loss that compromises hemodynamic stability. 2, 3
Tranexamic acid should be administered in every case of PPH regardless of etiology (uterine atony, genital‑tract trauma, or other causes). 2, 3
Timing is critical: the therapeutic benefit declines by ≈10 % for each 15‑minute delay; no benefit is observed after 3 hours, and administration beyond this window may be harmful. 2, 3, 4
Dosing regimen: 1 g IV over 10 minutes; a second 1 g dose may be given if bleeding persists after 30 minutes or recurs within 24 hours. 1, 2, 3

Tranexamic acid is indicated for trauma patients who are bleeding or at risk of major hemorrhage, and should be given as soon as possible and within 3 hours of injury. 5
Recommended dosing: loading dose 1 g IV over 10 minutes, followed by a continuous infusion of 1 g over 8 hours. 5
Evidence from the CRASH‑2 trial demonstrates that early administration of tranexamic acid reduces mortality in severely injured trauma patients. This is considered high‑quality randomized evidence. 1, 4
When feasible, tranexamic acid should be administered en route to the hospital (e.g., by emergency medical services). 5

Absolute contraindication: active intravascular clotting (e.g., ongoing thrombus formation). 5
Pregnancy‑related contraindication for the PPH indication: a known thromboembolic event during pregnancy. 2, 3

In the context of emergency or urgent surgical procedures, tranexamic acid reduces peri‑operative bleeding and the need for blood transfusion. This recommendation is based on the same high‑quality evidence supporting its life‑saving use. 1