A study, involving the London School of Hygiene & Tropical Medicine (LSHTM) researchers, has shown that tranexamic acid (TXA), a drug aimed at tackling serious postpartum bleeding, can be safely administered intramuscularly to pregnant women, quickly achieving effective therapeutic levels.
These results, derived from the Woman-PharmacoTXA Phase 2 trial, underscore the potential of using intramuscular injection as an alternative to the prevalent intravenous methods. The latter often proves impractical in circumstances such as home births or in remote healthcare environments.
Oral TXA was also well-tolerated, however, on average, took around one hour to reach therapeutic blood concentrations, meaning it could be unsuitable for emergency treatment.
Severe bleeding after childbirth, or postpartum hemorrhage (PPH), is one of the leading causes of maternal death worldwide, with most of the 70,000 yearly deaths occurring in low-and middle-income countries (LMICs).
Results from the earlier WOMAN trial, led by researchers from LSHTM with collaboration from 21 countries, provided crucial evidence for the life-saving potential of repurposing TXA for treating PPH.
Originally used in surgery and later in trauma, TXA works by inhibiting the breakdown of blood clots.
Although intravenous administration of TXA is the first port-of-call for treatment, many births in LMICs take place at home, with access to healthcare settings often limited. Subsequently, the focus has shifted towards finding alternative administration routes.
In this trial, an international research team, including from LSHTM, recruited over 120 women aged 18 or older who were due to give birth by cesarean section at two hospitals in Pakistan and one in Zambia between December 2020 and June 2021. All women had one or more risk factors for postpartum hemorrhage.
The study is the first trial testing several different routes of administration in women giving birth and notably the first to test the intramuscular route, specifically in pregnant women.
Overall, intramuscular and oral TXA were well tolerated, with no serious side effects for mothers or newborns. Target concentrations of TXA in maternal blood were achieved for both routes, although for oral TXA this took an hour – a characteristic that could prevent its use in emergency treatment. Intramuscular TXA, however, reached therapeutic concentrations within ten minutes of injection, which was maintained for over four hours.
The authors conclude that these findings provide enough evidence to conduct comparative Phase 3 clinical trials (I'M WOMAN) beginning in August this year. These will aim to determine if intramuscular administration is as effective as intravenous routes in reducing postpartum bleeding.
Professor Haleema Shakur-Still, co-author and Professor of Global Health Clinical Trials at LSHTM said: "In many LMICs, women do not give births in healthcare facilities, so if TXA can be given just as successfully intramuscularly as via intravenous injection, this could be of huge significance to the thousands of women who die every year from PPH."
Professor Rizwana Chaudhri, co-author based at Shifa Tameer-e-Millat University, Islamabad, Pakistan said: "The intramuscular route will be very helpful in Pakistan. With some patients who are experiencing a PPH, it is difficult to get an intravenous line established, so anything that can reduce PPH will be useful. In some cases, it will be the first and last choice."
Dr Mwansa Ketty Lubeya, co-author based at The University of Zambia-School of Medicine, Women and Newborn Hospital-UTH said: "In Zambia, we are still struggling with access to TXA. Even when it is available, there should be options in terms of administration. There is no point in having TXA when canulation is not an option. We are excited to have the intramuscular option and be able to use it far and wide."
Dr Ian Roberts, co-author and Professor of Epidemiology at LSHTM said: "We have good reason to believe the intramuscular route will be as effective as the intravenous route to reduce postpartum bleeding. In August, we are starting a large global trial to prove this in the hope that this will change WHO guidelines. We want to make this lifesaving treatment available to all women wherever they give birth."
News
Platelet-inspired nanoparticles could improve treatment of inflammatory diseases
Scientists have developed platelet-inspired nanoparticles that deliver anti-inflammatory drugs directly to brain-computer interface implants, doubling their effectiveness. Scientists have found a way to improve the performance of brain-computer interface (BCI) electrodes by delivering anti-inflammatory drugs directly [...]
After 150 years, a new chapter in cancer therapy is finally beginning
For decades, researchers have been looking for ways to destroy cancer cells in a targeted manner without further weakening the body. But for many patients whose immune system is severely impaired by chemotherapy or radiation, [...]
Older chemical libraries show promise for fighting resistant strains of COVID-19 virus
SARS‑CoV‑2, the virus that causes COVID-19, continues to mutate, with some newer strains becoming less responsive to current antiviral treatments like Paxlovid. Now, University of California San Diego scientists and an international team of [...]
Lower doses of immunotherapy for skin cancer give better results, study suggests
According to a new study, lower doses of approved immunotherapy for malignant melanoma can give better results against tumors, while reducing side effects. This is reported by researchers at Karolinska Institutet in the Journal of the National [...]
Researchers highlight five pathways through which microplastics can harm the brain
Microplastics could be fueling neurodegenerative diseases like Alzheimer's and Parkinson's, with a new study highlighting five ways microplastics can trigger inflammation and damage in the brain. More than 57 million people live with dementia, [...]
Tiny Metal Nanodots Obliterate Cancer Cells While Largely Sparing Healthy Tissue
Scientists have developed tiny metal-oxide particles that push cancer cells past their stress limits while sparing healthy tissue. An international team led by RMIT University has developed tiny particles called nanodots, crafted from a metallic compound, [...]
Gold Nanoclusters Could Supercharge Quantum Computers
Researchers found that gold “super atoms” can behave like the atoms in top-tier quantum systems—only far easier to scale. These tiny clusters can be customized at the molecular level, offering a powerful, tunable foundation [...]
A single shot of HPV vaccine may be enough to fight cervical cancer, study finds
WASHINGTON -- A single HPV vaccination appears just as effective as two doses at preventing the viral infection that causes cervical cancer, researchers reported Wednesday. HPV, or human papillomavirus, is very common and spread [...]
New technique overcomes technological barrier in 3D brain imaging
Scientists at the Swiss Light Source SLS have succeeded in mapping a piece of brain tissue in 3D at unprecedented resolution using X-rays, non-destructively. The breakthrough overcomes a long-standing technological barrier that had limited [...]
Scientists Uncover Hidden Blood Pattern in Long COVID
Researchers found persistent microclot and NET structures in Long COVID blood that may explain long-lasting symptoms. Researchers examining Long COVID have identified a structural connection between circulating microclots and neutrophil extracellular traps (NETs). The [...]
This Cellular Trick Helps Cancer Spread, but Could Also Stop It
Groups of normal cbiells can sense far into their surroundings, helping explain cancer cell migration. Understanding this ability could lead to new ways to limit tumor spread. The tale of the princess and the [...]
New mRNA therapy targets drug-resistant pneumonia
Bacteria that multiply on surfaces are a major headache in health care when they gain a foothold on, for example, implants or in catheters. Researchers at Chalmers University of Technology in Sweden have found [...]
Current Heart Health Guidelines Are Failing To Catch a Deadly Genetic Killer
New research reveals that standard screening misses most people with a common inherited cholesterol disorder. A Mayo Clinic study reports that current genetic screening guidelines overlook most people who have familial hypercholesterolemia, an inherited disorder that [...]
Scientists Identify the Evolutionary “Purpose” of Consciousness
Summary: Researchers at Ruhr University Bochum explore why consciousness evolved and why different species developed it in distinct ways. By comparing humans with birds, they show that complex awareness may arise through different neural architectures yet [...]
Novel mRNA therapy curbs antibiotic-resistant infections in preclinical lung models
Researchers at the Icahn School of Medicine at Mount Sinai and collaborators have reported early success with a novel mRNA-based therapy designed to combat antibiotic-resistant bacteria. The findings, published in Nature Biotechnology, show that in [...]
New skin-permeable polymer delivers insulin without needles
A breakthrough zwitterionic polymer slips through the skin’s toughest barriers, carrying insulin deep into tissue and normalizing blood sugar, offering patients a painless alternative to daily injections. A recent study published in the journal Nature examines [...]
