Prophylactic tranexamic acid for the prevention of postpartum haemorrhage in women with placenta praevia: multicentre, double blind, randomised, placebo controlled, phase 3 trial
Primary resultResult — go to the resultRelative risk 0.85 95.2% CI 0.75–0.96Authors' conclusion
In women with placenta praevia who underwent caesarean delivery and received prophylactic oxytocin, treatment with tranexamic acid resulted in a statistically significant yet modest reduction in the incidence of postpartum haemorrhage, with no signal of increased serious adverse events.
Study context
- Population
- Women with placenta praevia undergoing caesarean delivery, 24 maternity units across China, July 2023–March 20251,691 with primary outcome data
- Participants
- 1,732 women
- Comparison
- Prophylactic TXA vs placebo, with prophylactic oxytocin
- Tranexamic acidn = 845
- Placebon = 846reference
- Primary endpoint
- PPH: calculated estimated blood loss ≥1000 mL or red cell transfusion
- Follow-up
- Within two days after delivery
Methodological detailsmulticentre, double blind, placebo controlled, phase 3, 38 excluded after randomisation (withdrew consent or ineligible)
- Multicentre
- Double blind
- Placebo controlled
- Phase 3
- 38 excluded after randomisation (withdrew consent or ineligible)
Primary result
As reported in the abstract
Relative risk
0.85
95.2% CI 0.75–0.96
P = 0.01
Events by treatment group
Tranexamic acid vs Placebo
RR 0.85 (95.2% CI 0.75–0.96); P = 0.01
Further findings
- Placenta accreta spectrum diagnosed in 303 participants
- 17.9%
Safety
| Outcome | Tranexamic acid | Placebo | RR (95% CI) | |
|---|---|---|---|---|
| Serious adverse events (thromboembolic events, seizures, acute kidney or liver injury, maternal death)Similar between groups | 0.5% | 0.5% | 1.01 (0.25–4.00) | |
| 0.20.5125Relative risk (log scale) |
Original publication
Prophylactic tranexamic acid for the prevention of postpartum haemorrhage in women with placenta praevia: multicentre, double blind, randomised, placebo controlled, phase 3 trial. BMJ. Published 13 May 2026. doi:10.
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