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EBM opinion and debate
Maternal and child health
Best timing of tranexamic acid administration for bleeding after trauma or childbirth remains to be established
  1. Dacia DCA Henriquez1,
  2. Johanna G van der Bom1,2
  1. 1 Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
  2. 2 Center of Clinical Transfusion Research, Sanquin/ LUMC, Leiden, The Netherlands
  1. Correspondence to Dacia DCA Henriquez, Clinical Epidemiology, Leiden University Medical Center, Leiden 2300 RC, The Netherlands; d.d.c.a.henriquez{at}lumc.nl

https://doi.org/10.1136/bmjebm-2019-111290

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    Haemorrhage is worldwide the leading cause of maternal death1 and an important cause of death after trauma.2 Antifibrinolytic drugs inhibit the lysis of a fibrin clot and are, therefore, used to stop or prevent haemorrhage. Intravenous administration of tranexamic acid has been shown to reduce the risk of death due to haemorrhage after trauma3 and the risk of death due to postpartum haemorrhage.4 Previous analyses have suggested that tranexamic acid needs to be administered early after the start of haemorrhage, because effects of delayed administration might be absent or even harmful for patients suffering life-threatening bleeding.3 4 A recent systematic review and individual patient-level data meta-analysis was set up to quantify the effect of treatment delay on the effectiveness of antifibrinolytics.5

    This individual patient-level data meta-analysis was registered within PROSPERO and it adhered to the recognised protocols for systematic reviews and meta-analysis from The Cochrane Collaboration and the reporting guideline Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). It included randomised placebo-controlled trials (RCT) with more than 1000 patients with traumatic or postpartum haemorrhage; the authors argue that smaller studies have a lack of power and a risk of selection bias. The primary outcome for the meta-analysis was absence of death from bleeding. ‘Treatment delay’ was the exposure of interest and defined as the interval between bleeding …

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