Tranexamic acid to prevent bleeding after birth

Tranexamic acid is a medicine that helps blood clots last. Given early, it lowers deaths from bleeding in women who are already bleeding heavily after birth. This page is about a different use: giving it to prevent bleeding in women who are not yet bleeding heavily. In the WOMAN-2 trial, women with moderate or severe anaemia who got tranexamic acid right after a vaginal birth were no less likely to have a postpartum haemorrhage than women given a dummy treatment.

Intervention
In this atlas

Overview

Technical summary

Prevention use, kept apart from the treatment record (tranexamic-acid-pph-treatment): effects of one use do not transfer to the other. WOMAN-2 (Lancet 2024; PMID 39461792; NCT03475342): 15,068 women with moderate or severe anaemia after vaginal birth in four countries, no reduction in clinically diagnosed PPH. The 2025 global non-recommendation of tranexamic acid for prevention at vaginal and caesarean birth (Recommendations 14 and 15) is recorded on the existing treatment record; moving it here is for the integration step. Dose in the trial: 1 g by slow intravenous injection over 10 minutes within 15 minutes of cord clamping. This is not a recommendation to give it.

About this intervention

Type: Medicine
Mechanism: Not reported

Claims and evidence

Context Women with moderate or severe anaemia who gave birth vaginally, tranexamic acid within 15 minutes of cord clamping (WOMAN-2)

Recipient: Maternal
Population: Women of any age in active labour with moderate or severe anaemia (haemoglobin below 100 g/L) who had given birth vaginally and were randomly assigned to 1 g of tranexamic acid or matching placebo by slow intravenous injection (over 10 minutes) within 15 minutes of the umbilical cord being cut or clamped. Women had not yet had a postpartum haemorrhage that began before the cord was cut or clamped (registry exclusion). This is prevention, a different use from treating bleeding that has started.
Care setting: 34 hospitals across four countries
Geography: Nigeria, Pakistan, Tanzania and Zambia
Life stage: Childbirth, within 15 minutes after vaginal birth
Gestational age: Not reported
Postnatal age: Not reported
Follow-up: The primary outcome was assessed within 24 hours of randomisation.

Eligibility: 1 inclusion criterion; 1 exclusion criterion

Included: Women in active labour with moderate or severe anaemia (haemoglobin below 100 g/L), who gave birth vaginally
Excluded: Registry exclusions: women under 18 years who are not accompanied by a guardian, known allergy to tranexamic acid, and postpartum haemorrhage before the cord was cut or clamped

Effect Interventional Certainty not assessed

WOMAN-2 randomly assigned 7580 women with moderate or severe anaemia who gave birth vaginally to tranexamic acid and 7488 to placebo. Clinically diagnosed postpartum haemorrhage, the primary outcome, occurred in 530 of 7579 women (7.0%) in the tranexamic acid group and 497 of 7487 (6.6%) in the placebo group (risk ratio 1.05, 95% CI 0.94 to 1.19). The authors conclude that tranexamic acid given within 15 minutes of the umbilical cord being clamped did not reduce the risk of clinically diagnosed postpartum haemorrhage. No vascular occlusive events were reported in either group, and there were no treatment-related adverse events or deaths.
Applies to Maternal
- Women of any age in active labour with moderate or severe anaemia (haemoglobin below 100 g/L) who had given birth vaginally and were randomly assigned to 1 g of tranexamic acid or matching placebo by slow intravenous injection (over 10 minutes) within 15 minutes of the umbilical cord being cut or clamped. Women had not yet had a postpartum haemorrhage that began before the cord was cut or clamped (registry exclusion). This is prevention, a different use from treating bleeding that has started.
- 34 hospitals across four countries
- Nigeria, Pakistan, Tanzania and Zambia
- Childbirth, within 15 minutes after vaginal birth
- Gestational age Not reported
- Postnatal age Not reported
Follow-up The primary outcome was assessed within 24 hours of randomisation.
Certainty method
Not assessed

Limitations
This is a null result as reported: no reduction in the primary outcome. The primary outcome is a clinical diagnosis of postpartum haemorrhage, which might be an estimated blood loss of more than 500 mL or any blood loss sufficient to compromise haemodynamic stability within 24 hours. 358 (35%) of the 1024 women with postpartum haemorrhage for whom time data were available were diagnosed before the trial treatment had been fully administered, which the authors report. The trial studied prevention in anaemic women after vaginal birth; it does not apply to treating bleeding (the WOMAN trial, a different claim on a different record), to caesarean birth or to women without anaemia. Only the PubMed abstract and the registry JSON were read.

Last checked
2026-10-14

Next evidence check due
Not scheduled
Sources and citations (3)
1. Supports The effect of tranexamic acid on postpartum bleeding in women with moderate and severe anaemia (WOMAN-2): an international, randomised, double-blind, placebo-controlled trial
  
  Publication · Lancet (London, England) · Edition PubMed record (abstract and bibliographic data) from NCBI E-utilities. The full text and the version of record were not fetched. · Published 2024-10-26 · DOI: 10.1016/S0140-6736(24)01749-5 · PMID: 39461792
  
  Locator
  Abstract, BACKGROUND, METHODS: question, population, dose and timing, primary outcome
  
  How it applies
  PubMed abstract; the full text was not retrieved.
  
  Retrieved
  2026-10-14T18:18:29Z
  
  Source effective date
  Not reported
  
  Source state
  Current
  
  Snapshot hash
  060d08c5c1626d69ef98a2a2c898fc4c45a5c06d3fa4fdc38aa6c4ee4fc2cda6
  
  Reuse basis
  PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.
2. Supports The effect of tranexamic acid on postpartum bleeding in women with moderate and severe anaemia (WOMAN-2): an international, randomised, double-blind, placebo-controlled trial
  
  Publication · Lancet (London, England) · Edition PubMed record (abstract and bibliographic data) from NCBI E-utilities. The full text and the version of record were not fetched. · Published 2024-10-26 · DOI: 10.1016/S0140-6736(24)01749-5 · PMID: 39461792
  
  Locator
  Abstract, FINDINGS, sentences 2, 5, 6, 8 and 9: numbers randomised, timing, primary outcome, safety
  
  How it applies
  PubMed abstract.
  
  Retrieved
  2026-10-14T18:18:29Z
  
  Source effective date
  Not reported
  
  Source state
  Current
  
  Snapshot hash
  060d08c5c1626d69ef98a2a2c898fc4c45a5c06d3fa4fdc38aa6c4ee4fc2cda6
  
  Reuse basis
  PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.
3. Supports The effect of tranexamic acid on postpartum bleeding in women with moderate and severe anaemia (WOMAN-2): an international, randomised, double-blind, placebo-controlled trial
  
  Publication · Lancet (London, England) · Edition PubMed record (abstract and bibliographic data) from NCBI E-utilities. The full text and the version of record were not fetched. · Published 2024-10-26 · DOI: 10.1016/S0140-6736(24)01749-5 · PMID: 39461792
  
  Locator
  Abstract, INTERPRETATION
  
  How it applies
  PubMed abstract.
  
  Retrieved
  2026-10-14T18:18:29Z
  
  Source effective date
  Not reported
  
  Source state
  Current
  
  Snapshot hash
  060d08c5c1626d69ef98a2a2c898fc4c45a5c06d3fa4fdc38aa6c4ee4fc2cda6
  
  Reuse basis
  PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.

Clinical links

Each link reports what one cited claim says about one population. "Evaluated for" means studied, not shown to work. These links do not show that anything is effective or right for you.

Claim, not a settled fact WOMAN-2: no reduction in clinically diagnosed PPH in anaemic women after vaginal birth: Postpartum haemorrhage (Evaluated for)
Applies to Maternal
- Women of any age in active labour with moderate or severe anaemia (haemoglobin below 100 g/L) who had given birth vaginally and were randomly assigned to 1 g of tranexamic acid or matching placebo by slow intravenous injection (over 10 minutes) within 15 minutes of the umbilical cord being cut or clamped. Women had not yet had a postpartum haemorrhage that began before the cord was cut or clamped (registry exclusion). This is prevention, a different use from treating bleeding that has started.
- 34 hospitals across four countries
- Nigeria, Pakistan, Tanzania and Zambia
- Childbirth, within 15 minutes after vaginal birth
- Gestational age Not reported
- Postnatal age Not reported
Follow-up The primary outcome was assessed within 24 hours of randomisation.
WOMAN-2 randomly assigned 7580 women with moderate or severe anaemia who gave birth vaginally to tranexamic acid and 7488 to placebo. Clinically diagnosed postpartum haemorrhage, the primary outcome, occurred in 530 of 7579 women (7.0%) in the tranexamic acid group and 497 of 7487 (6.6%) in the placebo group (risk ratio 1.05, 95% CI 0.94 to 1.19). The authors conclude that tranexamic acid given within 15 minutes of the umbilical cord being clamped did not reduce the risk of clinically diagnosed postpartum haemorrhage. No vascular occlusive events were reported in either group, and there were no treatment-related adverse events or deaths.
Limitations. This is a null result as reported: no reduction in the primary outcome. The primary outcome is a clinical diagnosis of postpartum haemorrhage, which might be an estimated blood loss of more than 500 mL or any blood loss sufficient to compromise haemodynamic stability within 24 hours. 358 (35%) of the 1024 women with postpartum haemorrhage for whom time data were available were diagnosed before the trial treatment had been fully administered, which the authors report. The trial studied prevention in anaemic women after vaginal birth; it does not apply to treating bleeding (the WOMAN trial, a different claim on a different record), to caesarean birth or to women without anaemia. Only the PubMed abstract and the registry JSON were read.

Record details

Record id: maternal:tranexamic-acid-pph-prevention
Content hash: 277c3558859380eac1a5f20b7d828da0fc8b8c7ebe273b279300bd6b8a841873