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.