Tranexamic acid and its use in early pregnancy; a scoping review

Bleeding in early pregnancy is reported in 1 in 4 of pregnancies and is linked to increased risks of miscarriage, preterm birth, low birth weight, placental abruption, and stillbirth. Current treatments are limited and none of the recommended treatments target cessation of bleeding. Tranexamic acid (TXA), an antifibrinolytic agent, presents a potential option for halting bleeding in early pregnancy, potentially reducing the risk of associated adverse outcomes.

To review the current literature on the use and efficacy of TXA in early pregnancy.

A scoping review was conducted using JBI methodology. Searches were performed in Embase, Medline, CENTRAL, and grey literature. Three separate searches assessed TXA's efficacy in early pregnancy, safety profile during pregnancy, and potential teratogenicity.

Four studies met inclusion criteria for efficacy: three non-randomised prospective trials and one observational study, totaling 319 patients. Studies had small sample sizes and varied methodologies. For safety, 30 studies involving 76,302 patients were included: 13 systematic reviews/meta-analyses, 13 RCTs, 2 retrospective cohorts, 1 prospective case-control study, and 1 open-label dose-ranging study. Most focused on postpartum haemorrhage. No significant increase in venous thromboembolism was observed with TXA versus control. No case-control studies evaluated teratogenicity directly. However, 22 studies from 14 countries reported TXA use in pregnancy (not related to postpartum haemorrhage). Among 234 pregnancies exposed to TXA, 230 (98%) resulted in live births.

Evidence for TXA use in early pregnancy is limited, with small, low-quality studies. Larger, high-quality trials are needed to determine safety and efficacy.