During obstetric hemorrhage with uterine atony, which agent reduces bleeding by inhibiting fibrinolysis?

• A. Tranexamic acid
• B. Oxytocin
• C. Methylergonovine
• D. Furosemide

Answer: (A)

The main concept is that tranexamic acid reduces bleeding by inhibiting fibrinolysis. In obstetric hemorrhage from uterine atony, clots formed at sites of bleeding are often broken down too quickly, perpetuating blood loss. Tranexamic acid is an antifibrinolytic that works by blocking plasminogen from being converted to plasmin and by inhibiting plasmin activity, which slows the degradation of fibrin clots. This helps stabilize clots and lessen bleeding when used as an adjunct to uterotonic therapy. It’s given intravenously (commonly 1 g over 10–20 minutes, with a second dose if bleeding continues, up to a total of 2 g) and should be administered early, ideally within 3 hours of onset, to maximize benefit. The other options are uterotonics or unrelated drugs: oxytocin and methylergonovine increase uterine tone to reduce bleeding, not by inhibiting fibrinolysis; furosemide is a diuretic with no role in controlling hemorrhage.