Tranexamic acid for anemia in women of reproductive age: A systematic review of randomized trials.
Sima Berendes, Katharine Ker, Hilary O D Critchley et al.
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In 30 seconds
This systematic review and meta-analysis assessed randomized trials of tranexamic acid (TXA) versus placebo or standard care for uterine bleeding in women of reproductive age. Seventeen trials were included in the review and 15 in meta-analyses. No trial provided adequate hemoglobin data, and anemia results came from one small trial, leaving TXA’s effect on anemia uncertain. In women with heavy menstrual bleeding, TXA reduced objectively measured blood loss by a mean of -47.0 milliliters (95% confidence interval -56.6 to -37.4; 6 trials; moderate-certainty evidence).
Key findings
- No included trial reported adequate data on hemoglobin concentration.
- One small trial assessed anemia: risk ratio 0.15, 95% confidence interval 0.01 to 2.74; certainty was very low.
- For heavy menstrual bleeding, TXA reduced measured blood loss by -47.0 milliliters (95% confidence interval -56.6 to -37.4; 6 trials; moderate certainty).
- Nausea or vomiting risk was similar between groups: risk ratio 1.0, 95% confidence interval 0.6 to 1.8; 4 trials; moderate certainty.
Why it matters
Menstrual blood loss can be relevant to anemia, but evidence that TXA improves anemia itself remains insufficient. The review separates a demonstrated reduction in blood loss for heavy menstrual bleeding from the unanswered question of whether this translates into higher hemoglobin or lower anemia prevalence. This distinction is important when interpreting TXA’s potential role in addressing anemia.
What to keep in mind
Hemoglobin data were inadequate, and anemia evidence came from only one small trial with very low certainty. Evidence for other outcomes, including thromboembolic events, was limited and ranged from very low to low certainty.