The expanding role of tranexamic acid in the management of obstetric hemorrhage

Reducing mortality and morbidity in obstetric patients presents challenges at each end of the coagulation spectrum. The greatest cause of maternal mortality worldwide is from hemorrhage, and yet women also die in large numbers from peripartum pulmonary embolism (1). Pharmacologic manipulation of the coagulation cascade, including the use of the antifbrinolytic tranexamic acid, has become an important part of reducing hemorrhage risk in cardiac, trauma, and orthopedic patients (2), and will now likely become a more common practice in obstetric management with the recent publication of the World Maternal Antifibrinolytic (WOMAN) trial (3).