Alternative routes to intravenous tranexamic acid for postpartum hemorrhage: A systematic search and narrative review
Related Experiment Video
Updated: Sep 6, 2025

A New Hybrid Quantitative Evaluation Model for Axillary Junctional Hemorrhage in Swine
Published on: December 6, 2024
Haleema Shakur-Still1, Stanislas Grassin-Delyle2,3, Kopalasuntharam Muhunthan4
1Clinical Trials Unit, London School of Hygiene and Tropical Medicine, London, UK.
Objective:
To review available data on tranexamic acid (TXA) plasma concentration needed to inhibit fibrinolysis and the time to achieve this concentration when giving TXA by different routes in humans. To identify ongoing trials assessing alternatives to intravenous TXA administration.
Methods:
We updated two previous systematic reviews by searching MEDLINE, EMBASE, OviSP, and ISI Web of Science from database inception to July 2021. We also searched the WHO International Clinical Trials Registry Platform for ongoing trials to July 2021. Titles and abstracts were screened for relevant trials. Two reviewers independently reviewed and agreed the trials to be included.
Results:
Plasma TXA concentrations over 10 mg/L provide near maximal inhibition of fibrinolysis, with concentrations over 5 mg/L providing partial inhibition. Oral TXA tablets take about 1 h to reach a plasma concentration of 5 mg/L in postpartum women. Studies in healthy volunteers and shocked trauma patients show that intramuscular TXA achieves a plasma level of over 10 mg/L within 15 min. One trial is ongoing to determine the pharmacokinetics of intramuscular and oral solution TXA in pregnant women.
Conclusion:
Intramuscular TXA in healthy volunteers and shocked trauma patients reaches therapeutic concentration rapidly. Oral TXA tablets take too long to reach the minimum therapeutic concentration in postpartum women.
Related Concept Videos
Drug Delivery: Parenteral Route
There are three primary parenteral routes: intravenous (IV), intramuscular (IM), and subcutaneous (SC). The IV route introduces the drug directly into the bloodstream, ensuring immediate action. The IM route...
Anticoagulant Drugs: Low-Molecular-Weight Heparins
Routes of Drug Administration: Parenteral
The intravenous route (IV) of drug administration can be further categorized into two types. The bolus injection administers the entire dose rapidly, while an intravenous infusion slowly delivers smaller doses steadily.
The IV route is often...
Venous Thrombosis III: Interprofessional Care
Local Anesthetics: Clinical Application as Intravenous Regional Anesthesia
One of the advantages of...
Venous Thrombosis IV: Nursing Management

