WHO
March 2022
WHO recommends early use of intravenous Tranexamic Acid (TXA) within 3 hours of birth in addition to standard care for women with PPH. WHO is now alerting health care professionals about the risk of administration errors that can occur with Tranexamic Acid (TXA) injection (TXA has been mistaken for obstetric spinal anaesthesia used for caesarean deliveries resulting in inadvertent intrathecal administration).
TXA is a lifesaving medicine, however, this potential clinical risk should be considered and addressed. Review existing operating theatre drug handling practices to decrease this risk, i.e. store TXA away from the anaesthetic drug trolley, and preferably outside the theatre.
Key Takeaways
- Intrathecal TXA is a potent neurotoxin, with refractory seizures and 50% mortality.
- TXA should be administered at a fixed dose of 1g in 10 ml (100 mg/ml) IV at 1 ml per minute, with a second dose of 1g IV if bleeding continues after 30 minutes.
- The presentation of some of local anesthetics is similar to TXA (transparent ampoule containing transparent solution), which can erroneously be administered instead of the intended intrathecal anesthetic resulting in serious adverse effects.
- Obstetricians from several countries have reported inadvertent intrathecal TXA administration and related serious neurological injuries.