Tranexamic Acid Modestly Reduces Postpartum Hemorrhage in Placenta Praevia: BMJ
Researchers have discovered in new research that among women with placenta praevia undergoing cesarean delivery who received prophylactic oxytocin, the addition of tranexamic acid led to a statistically significant but modest reduction in the incidence of postpartum hemorrhage. Importantly, the treatment was not associated with an increase in serious adverse events, supporting its potential role as an adjunctive strategy to reduce bleeding risk in this high-risk population. The study was published in BMJ journal by Lizi Z. and colleagues.
Researchers carried out a phase 3 randomized clinical trial in twenty-four specialized maternity centers throughout China from July 2023 to March 2025. They enrolled a considerable number of patients with placenta praevia who needed cesarean delivery in their recruitment strategy. Immediately after umbilical cord clamping, patients were randomly allocated on a 1:1 basis in such a way that some patients took the active antifibrinolytic agent while the other group took a visually similar placebo along with the use of oxytocin for prophylaxis. In the former group, 1 g tranexamic acid solution in 10 ml was used which is diluted in 40 ml normal saline and given in 10 minutes intravenous infusion.
In the latter group, 10 ml of normal saline solution was given through intravenous route in 10 minutes, starting immediately after 5 minutes of umbilical cord clamping. For the sake of blinding, all patients and healthcare providers were unaware of patient grouping. Postpartum hemorrhage was used as the main criterion by measuring blood loss of 1000 ml or requiring red cell transfusion within two days of birth. Serious adverse events like thromboembolic events, seizures, acute renal/ hepatic injury, and mortality were recorded in patients.
Key findings:
- For the multi-centre clinical trial, randomization was done to a total pool of 1732 women with placenta praevia in the 24 recruited maternity units.
- After randomization, exclusion criteria included a withdrawal of consent from participation or formal designation as an ineligible participant, where a total of 38 patients had to be excluded from the analysis.
- Data for the primary outcome was obtained and analyzed in 99.8% of the patients who constituted 1691/1694 individuals.
- Among those who had primary outcome data evaluated, a very dangerous placenta accreta spectrum complication was found in 303 participants, which is equivalent to 17.9% of patients.
- Of the evaluated participants, 29.7% of those on tranexamic acid (251 out of 845 patients) suffered from primary outcome, while those on placebo accounted for 35.1% (297 out of 846 patients).
- This resulted in a statistically significant relative risk reduction of 0.85, which falls within the 95.2% confidence interval (0.75 to 0.96), P=0.01.
- Serious adverse events in both groups were surprisingly low, each accounting for 0.5% of patients (4 out of 837 on tranexamic acid, and 4 out of 845 on placebo; relative risk 1.01, 95% CI 0.25 to 4.00).
In summary, among women who had placenta previa, underwent caesarian delivery, and were administered oxytocin, the administration of tranexamic acid showed an improvement in the risk of developing postpartum hemorrhage in these women, although to only a small extent. Furthermore, there was no evidence of any increase in the risk of adverse events. Overall, the results obtained in this study can be considered quite encouraging regarding maternal medicine.
Reference:
Zhang, L., Bi, S., Chen, L., Du, L., He, F., Qiao, Y., Li, Z., Zeng, W., Zhao, X., Chen, X., Li, X., Ding, G., Zhou, W., Sun, B., Guo, Q., Guo, X., Jin, F., Wang, X., Zhu, Q., Sun, Q., … study’s collaborator group (2026). Prophylactic tranexamic acid for the prevention of postpartum haemorrhage in women with placenta praevia: multicentre, double blind, randomised, placebo controlled, phase 3 trial. BMJ (Clinical research ed.), 393, e089636. https://doi.org/10.1136/bmj-2026-089636
