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Is tranexamic acid effective for acute upper gastrointestinal bleeding?

Sebastián Flores1, Carolina Avilés2, Gabriel Rada3

  • 1Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; Proyecto Epistemonikos, Santiago, Chile. Address: Facultad de Medicina, Pontificia Universidad Católica de Chile, Lira 63, Santiago Centro, Chile.

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Tranexamic acid likely reduces rebleeding and mortality in upper gastrointestinal bleeding emergencies. This antifibrinolytic agent appears safe, without increasing harmful blood clots, offering a potential benefit for patients.

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Area of Science:

  • Gastroenterology
  • Emergency Medicine
  • Pharmacology

Background:

  • Upper gastrointestinal bleeding is a critical condition with significant mortality and morbidity.
  • The efficacy of tranexamic acid, an antifibrinolytic agent, in managing this condition remains debated.
  • Identifying effective treatments is crucial for improving patient outcomes.

Purpose of the Study:

  • To evaluate the effectiveness and safety of tranexamic acid in patients with upper gastrointestinal bleeding.
  • To synthesize current evidence from randomized controlled trials on tranexamic acid's role.
  • To provide a GRADE-based summary of findings regarding rebleeding, mortality, and adverse events.

Main Methods:

  • A comprehensive search was conducted in the Epistemonikos database, screening 30 sources.
  • Five systematic reviews encompassing eight randomized trials were identified and included.
  • Meta-analysis was employed to combine evidence, with findings summarized using the GRADE approach.

Main Results:

  • Tranexamic acid was associated with a probable decrease in rebleeding rates.
  • A likely reduction in mortality was observed in patients treated with tranexamic acid.
  • No significant increase in thromboembolic adverse effects was detected.

Conclusions:

  • Tranexamic acid is likely beneficial in reducing rebleeding and mortality in upper gastrointestinal bleeding.
  • The use of tranexamic acid does not appear to elevate the risk of thromboembolic events.
  • This evidence supports the consideration of tranexamic acid in the management protocols for upper GI bleeding.