Clinical implications
Administration of IV fluids, OXY (IV or IM) and TXA (IV) is recommended as standard of care by the WHO for the treatment of PPH1. Since both IV TXA and therapeutic OXY are administered in IV bags, intuitively there will be inclination to put the two drugs together. In the WOMAN trial (WOMAN Trial Collaborators. Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial) 99% of all women in TXA group received therapeutic OXY although it is not clear whether they were mixed in the infusion bags or not 4.
Key elements of the PPH first response bundle are the administration of uterotonic drugs (with OXY injection preferred where quality can be assured), TXA injection and IV fluids. The co-administration of these three elements by IV infusion offers the potential to simplify administration in situations where resource constraints exist.
However, the results of this preliminary study indicate that the potential exists for the mixing of OXY and TXA injection products in IV fluids to result in a significant loss of OXY in the mixed solution. OXY loss was observed in approximately 25% of combinations tested and if these results are replicated in a clinical setting, this practice may result in an underdosing of OXY, compromising care in an emergency life-threatening situation.