A drug that was invented, and largely overlooked, in the 1960s is now being praised for its ability to drastically decrease maternal deaths due to postpartum hemorrhaging, or excessive bleeding during and after childbirth.
In 1962, husband and wife research team Shosuke and Utako Okamoto were living in post-WWII Japan. As doctors with limited resources, they realized the one resource they could work with: blood. Even if it meant using their own, they strove to create a drug to prevent major blood loss after trauma.
“We wanted to work on something international, we wanted to discover new drugs to show our gratitude to humanity,” Utako said.
From that gratitude came the invention of tranexamic acid, which is widely used to treat excessive bleeding after surgery, trauma, tooth removal, nosebleeds and heavy menstruation. The drug can be taken orally or intravenously and works by inhibiting the breakdown of blood clots to stop heavy bleeding. It’s one of the drugs on the World Health Organization’s List of Essential Medicines, comprised of the safest and most effective medicines needed in the healthcare system.
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However, before its inclusion on that list, tranexamic acid wasn’t fully recognized for its potential in helping women survive bleeding from childbirth. Although it was Utako’s dream to save women’s lives with use of the drug, she couldn’t convince the doctors at the time to test tranexamic acid on postpartum hemorrhaging. As a result, it was marketed as a drug for treating heavy periods.
A Second Look to Save Lives
Postpartum hemorrhaging takes the lives of approximately 100,000 women every year and is thus the leading cause of maternal deaths worldwide.
In studying ways to reduce this maternal mortality, a group of researchers at the London School of Hygiene & Tropical Medicine revisited tranexamic acid, realizing its vast potential for treating this issue. Ian Roberts, a Professor of Epidemiology & Public Health and Co-Director of the Clinical Trials Unit at the London School of Hygiene & Tropical Medicine, questioned why a drug that was widely used in stopping minor bleeding wasn’t being used for bleeding that could cause death.
“There was no commercial interest in evaluating it,” Roberts said. “People just overlooked it completely.”
Knowing that tranexamic acid reduced deaths related to bleeding by one-third in trauma patients, and inspired by Utako’s foresight, Roberts and his fellow researchers set out to conduct a trial to test its effectiveness for postpartum hemorrhaging in 2010. After six years, the WOMAN trial recently reached its goal of securing 20,000 women as patients.
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The results of the trial showed that tranexamic acid reduced the number of deaths related to postpartum hemorrhaging by 31 percent when patients received the drug within three hours after childbirth. What’s more, the women who received the drug had no adverse effects.
The researchers’ interpretation of the results was for doctors to administer tranexamic acid as soon as possible after the onset of bleeding as a treatment for postpartum hemorrhaging. The findings of the trial purport tranexamic acid as not only an effective drug for saving lives but also an inexpensive and safe one. The drug is available in the UK for around $3 and even less in low-income countries.
Utako Okamoto passed away shortly after the WOMAN trial reached its goal. Had it not been for her inspiring story of gratitude and determination, perhaps the researchers would not have revisited this life-saving drug.
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