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Chapter 1: What is tranexamic acid and why is it significant?
Tranexamic acid has this amazing story. It really is a story of struggle and misogyny and everything bad you can imagine in science.
Discovery doesn't always happen in a straight line. Sometimes it's a longer path, shaped by who gets listened to and who doesn't. Tranexamic acid, or TXA, is one of those stories. First discovered in 1960s Japan, it took five decades for the drug to be used for its original purpose, preventing postpartum hemorrhage, which is still one of the leading causes of maternal deaths worldwide.
Since the early 2010s, a series of trials by the London School of Hygiene and Tropical Medicine have been exploring how it can be used to save women's lives. And they have made life-changing discoveries. But their path hasn't always run smooth.
We went in believing something and the result shocked us into learning even more.
This episode, we are diving into the incredible story of the women trials with Halima Shaker-Still, one of the lead investigators across the full women research portfolio. I'm Alicia Wainwright. This is When Science Finds a Way, a podcast about the science changing the world. Okay, let's meet Halima. I'm so excited to have this conversation.
I have a lot of questions on deck, but firstly, I just want to ask if you can say your name and what you do.
I'm Halima Shukur Still. I'm an emeritus professor of global health clinical trials at the London School of Hygiene and Tropical Medicine.
Can you tell me what inspired you to get involved in the women trials?
I was never really interested in women's health because it was never on my horizon. I started life as a nurse and I never actually did women's health. I have no idea why I managed to bypass that totally. And In my research life, I was very interested in traumatic injuries. Because I think I had a really major brain injury when I was younger. And I had a massive hemorrhage.
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Chapter 2: How did tranexamic acid's journey begin in post-war Japan?
And we were doing a trial of traumatic injuries, looking for ways of stopping people bleeding to death. And we were doing the trial in over 50 countries around the world. And I was absolutely enjoying it because I was really privileged to go and visit people hospitals around the world, you know, from Latin America to Africa to Asia. And I was in a hospital in Nigeria, in the capital city, Abuja.
And we were doing what we're supposed to do as trialists, go and check the trial is being done correctly. And the trial we were doing at that time was called CRASH 2. And CRASH 2, we were really pleased. It was doing very well at this site. And I was just telling the doctor who was looking after the trial at the site how pleased I was. And we were standing in the emergency department at the time.
And patients were coming in and sort of going to different places. And A patient came in, was rushed behind a curtain and the next few minutes I could hear, you know, frantic efforts of resuscitation and a little bit later, just screaming. And at the time I thought, you know, what's this? So I said to the doctor that was with us, I said, what's going on?
And he said, um, that's a woman who's just come in with postpartum hemorrhage and we haven't been able to save her. She's died.
Wow.
And he said to us, you're looking at tranexamic acid for traumatic injuries. Why aren't you looking at it for women who bleed to death after childbirth? And at the time I thought, you know, women don't really die of postpartum haemorrhage because I'm privileged to live in a very rich country where women don't often die of postpartum haemorrhage.
And that was the reason it wasn't even on my horizon. But he said that it was an everyday occurrence to them. This was something they were dealing with every day.
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Chapter 3: What challenges did researchers face in promoting TXA for postpartum hemorrhage?
And by the time women came to them, they weren't surviving. And they felt it didn't have the treatments that could save their lives. So we went away and started looking at, you know, what else could be done for women who bleed to death. And at the same time, we were doing the CRASH-2 trial of tranexamic acid in trauma patients. we started looking at whether it could be useful for women.
And we started the woman trial even before we knew the results of the CRASH-2 trial. Interesting.
So this is around 2010 where tranexamic acid was not a new drug. I wonder if you could tell me a little bit about how it was discovered and what it was initially used for.
Tranexamic acid has this amazing story. It really is a story of struggle and misogyny and everything bad you can imagine in science. Imagine Japan after the Second World War having had two bombs dropped on it.
Chapter 4: How did the WOMAN trials contribute to understanding postpartum hemorrhage?
And there is someone working there who still believed in humanity. And there was this amazing woman called Otoko Okamoto. At the time she was working in Japan, women were still dying in huge numbers in childbirth. And she wanted to find better ways of looking after these women. She wanted to save their lives. And post-war Japan wasn't an easy place to do research.
But if you had your own blood, you could work on your own blood if you couldn't afford to buy reagents and everything else. So she decided she was going to work on their own blood because then they didn't have to spend money or find reagents or cell lines or all the other things you needed money for. But what was driving her was that she actually said she wanted to do something for humanity.
So she set about discovering a treatment that could stop bleeding. And she did discover this treatment called tranexamic acid.
Wow.
But she couldn't convince the doctors who were primarily male in Japan to do the trials needed to see whether it could save the lives of women. So for most of its early life, tranexamic acid was used for minor bleeds like tooth extraction, minor surgery, et cetera.
Eventually, 50 years later, was when we did the study, the woman trial, that fulfilled her original dream of looking at tranexamic acid as a treatment for postpartum hemorrhage.
That's, that's a lot to take in only because 50 years is such a long time to have so many women dying of postpartum hemorrhage. I wonder if you could just briefly explain what postpartum hemorrhage is.
Postpartum hemorrhage is a very complex thing, but it's basically any bleeding that could lead to a life being threatened after childbirth.
Let's move forward to 2010 when the women trial first began. I wonder if you can talk us through the scale of the trial and what your focus was on.
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