Research Article|Articles in Press, 100933

An update to tranexamic acid (TXA) trends during the peripartum period in the United States, 2019 – 2021



      Results from the 2017 World Maternal Antifibrinolytic (WOMAN) trial found that patients who received tranexamic acid (TXA) during delivery had significantly lower rates of death and hysterectomy. Several months after the WOMAN trial publication, ACOG endorsed the consideration of TXA usage when traditional uterotonics fail during postpartum hemorrhage (PPH). Since then, TXA usage has become more mainstream for the treatment of PPH.


      This study aimed to evaluate TXA trends in obstetrics both temporally and geographically within the United States (US). Additional outcomes included patient demographics and perinatal outcomes.

      Study Design

      This retrospective cohort study included 19 hospitals, divided into East, Central, and West geographic regions, within the Universal Health Services, Incorporated network. Rates of TXA use were compared from July 2019 through June 2021. Patient demographics and perinatal outcomes were analyzed for TXA recipients.


      During the two-year study period, 3.2% (1,580/50,150) of patients received TXA during delivery. The western region of the US demonstrated increased TXA use over the two-year study period. Recipients of TXA were more likely to have a history of postpartum hemorrhage (p < 0.0001), chronic hypertension (p < 0.0001), preeclampsia (p < 0.0001), and/or diabetes (p = 0.004). Patients who received TXA did not have an increased likelihood of venous thromboembolism in comparison to those who did not receive TXA (8 [0.5%] vs. 226 [0.5%], p = 0.77). Of those who received TXA, 53.2% (840/1580) had an estimated blood loss less than 1000 mL.


      Nationally, a higher percentage of patients received TXA without a PPH diagnosis compared to prior studies, and the western region of the US had an overall increased use in TXA during delivery compared to prior years. The greatest frequency of TXA use remains in the western region. There was no increased risk of venous thromboembolism in those who received TXA, regardless of PPH diagnosis.


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