The impact of the WOMAN trial on local clinical practice in Thailand

The World Maternal Antifibrinolytic (WOMAN) trial, published in 2017, was a multicenter, randomized controlled study. Its findings demonstrated that administering 1 g of tranexamic acid within 3 h postpartum can reduce maternal mortality due to hemorrhage by one-third. Importantly, this intervention did not increase adverse events such as thromboembolism. Consequently, the World Health Organization now recommends administering 1 g of tranexamic acid within 3 h postpartum for all patients diagnosed with postpartum hemorrhage (PPH). This recommendation applies regardless of the delivery method. Our investigation involved examining data from the largest university hospital in Thailand over five years (2016‒2020). The dataset included 649 cases of PPH out of 17,187 cesarean deliveries. Our analysis revealed a significant increase in the utilization of tranexamic acid after the WOMAN trial. However, we found no significant differences in maternal outcomes, such as the rate of blood transfusion, the proportion of patients who experienced massive bleeding, or the rate of hysterectomy. This global initiative has influenced clinical practices at our institution, suggesting a need for broader implementation of tranexamic acid utilization across all healthcare centers in Thailand. Clinical trial registration: ClinicalTrials.gov registration number: NCT04833556 (registered April 6, 2021).