†These authors contributed equally to this work.
Tranexamic acid (TXA), an antifibrinolytic agent, has recently been investigated as a potentially useful drug for both prevention and treatment of Primary Postpartum Hemorrhage (PPH). This article highlights the continuing evolvement of this antifibrinolytic medication in the broad field of anesthesiology, and more specifically, obstetric anesthesiology, focusing on three important aspects of TXA administration: the continuing studies and assessment of the potential benefits of TXA administration to minimize PPH in both non high risk and high risk parturients, the possible adverse effects of TXA on the mother, and finally the unknown risks of the administration of TXA to the neonate. Although there is promise in the use of TXA for prevention and treatment of PPH, large, high quality randomized controlled trials are necessary on all three of these aspects before its widespread use can be recommended safely. Until that time, it is imperative that the anesthesiologist be well informed on this delicate balance of potential benefit of TXA to the mother versus potential and unknown risk to the mother and neonate.
Keywords: Perioperative complications, high risk obstetric parturients, primary postpartum hemorrhage, tranexamic acid, anesthetic issues and peri-operative care, preoperative evaluation and anesthesia risk, antifibrinolytics