{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T21:12:27Z","timestamp":1781557947372,"version":"3.54.5"},"reference-count":34,"publisher":"Wiley","issue":"S1","license":[{"start":{"date-parts":[[2022,6,28]],"date-time":"2022-06-28T00:00:00Z","timestamp":1656374400000},"content-version":"vor","delay-in-days":27,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Intl J Gynecology &amp; Obste"],"published-print":{"date-parts":[[2022,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>To review available data on tranexamic acid (TXA) plasma concentration needed to inhibit fibrinolysis and the time to achieve this concentration when giving TXA by different routes in humans. To identify ongoing trials assessing alternatives to intravenous TXA administration.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We updated two previous systematic reviews by searching MEDLINE, EMBASE, OviSP, and ISI Web of Science from database inception to July 2021. We also searched the WHO International Clinical Trials Registry Platform for ongoing trials to July 2021. Titles and abstracts were screened for relevant trials. Two reviewers independently reviewed and agreed the trials to be included.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Plasma TXA concentrations over 10\u2009mg\/L provide near maximal inhibition of fibrinolysis, with concentrations over 5\u2009mg\/L providing partial inhibition. Oral TXA tablets take about 1\u2009h to reach a plasma concentration of 5\u2009mg\/L in postpartum women. Studies in healthy volunteers and shocked trauma patients show that intramuscular TXA achieves a plasma level of over 10\u2009mg\/L within 15\u2009min. One trial is ongoing to determine the pharmacokinetics of intramuscular and oral solution TXA in pregnant women.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Intramuscular TXA in healthy volunteers and shocked trauma patients reaches therapeutic concentration rapidly. Oral TXA tablets take too long to reach the minimum therapeutic concentration in postpartum women.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ijgo.14201","type":"journal-article","created":{"date-parts":[[2022,6,28]],"date-time":"2022-06-28T13:24:30Z","timestamp":1656422670000},"page":"40-45","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Alternative routes to intravenous tranexamic acid for postpartum hemorrhage: A systematic search and narrative review"],"prefix":"10.1002","volume":"158","author":[{"given":"Haleema","family":"Shakur\u2010Still","sequence":"first","affiliation":[{"name":"Clinical Trials Unit London School of Hygiene and Tropical Medicine  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stanislas","family":"Grassin\u2010Delyle","sequence":"additional","affiliation":[{"name":"D\u00e9partement des maladies des voies respiratoires H\u00f4pital Foch  Suresnes France"},{"name":"Infection et inflammation, D\u00e9partement de Biotechnologie de la Sant\u00e9, UVSQ, INSERM Universit\u00e9 Paris\u2010Saclay  Montigny le Bretonneux France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kopalasuntharam","family":"Muhunthan","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology University of Jaffna  Jaffna Sri Lanka"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Homa K.","family":"Ahmadzia","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Division of Maternal\u2010Fetal Medicine George Washington University  Washington District of Columbia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Faraoni","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Perioperative and Pain Medicine, Arthur S. 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