POSTPARTUM HEMORRHAGE AND TRANEXAMIC ACID: CURRENT EVIDENCE

Анотація

Postpartum hemorrhage (PPH) remains one of the leading causes of maternal mortality and disability worldwide. According to national clinical guidelines, PPH is defined as blood loss of 500 mL or more following childbirth or any amount of blood loss resulting in hemodynamic instability. The primary etiological factor is uterine atony, accounting for approximately 70% of cases, along with other components of the "4Ts" concept (Tissue, Trauma, Thrombin). Tranexamic acid is a potent synthetic antifibrinolytic agent and a lysine analogue that stabilizes the fibrin clot by competitively inhibiting plasminogen activation and directly suppressing plasmin activity. The drug rapidly reaches therapeutic plasma concentrations, has a relatively short elimination half-life, and demonstrates a favorable safety profile.

The aim of the study was to substantiate the clinical rationale and pathogenetic effectiveness of tranexamic acid in the comprehensive treatment and prevention of postpartum hemorrhage in order to reduce blood loss, prevent coagulopathy, and decrease the need for blood transfusions.

The article analyzes data from large randomized controlled trials, systematic reviews, and meta-analyses. Timely administration of tranexamic acid within the first three hours after the onset of bleeding significantly reduces hemorrhage-related mortality, the risk of life-threatening complications, the volume of blood loss (by 32–92 mL depending on the mode of delivery), and the need for blood transfusions (by 38–39%). Prophylactic use in high-risk women reduces the incidence of hemorrhagic complications. The greatest therapeutic benefit is achieved when the drug is administered within the so-called "golden hour."

The safety profile of tranexamic acid is favorable, with the incidence of thromboembolic events not exceeding that observed in placebo groups. The most commonly reported adverse effects are nausea and vomiting.

Current evidence confirms the high efficacy and safety of tranexamic acid, supporting its widespread incorporation into modern protocols for the management of obstetric hemorrhage and the improvement of maternal outcomes.

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