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Published on: January 19, 2024
Topical tranexamic acid as a novel treatment for bleeding peptic ulcer: A randomised controlled trial
Mandana Rafeey1, Maryam Shoaran2, Robabeh Ghergherechi3
1Department of Pediatrics, Liver and Gastrointestinal Research Centre, Tabriz University of Medical Sciences, Tabriz, Iran.
Insights
Topical tranexamic acid (TXA) applied during endoscopy shows potential for treating pediatric gastrointestinal bleeding from ulcers. Further large-scale studies are needed to confirm its efficacy in managing bleeding ulcers in children.
Area of Science:
- Pediatric Gastroenterology
- Endoscopic Hemostasis
- Pharmacological Interventions
Background:
- Peptic ulcers are a frequent cause of upper GI bleeding in pediatric patients.
- Endoscopy is the standard diagnostic and therapeutic approach for GI bleeding.
- The study investigates a novel topical treatment for bleeding ulcers.
Purpose of the Study:
- To evaluate the efficacy of topical tranexamic acid (TXA) in managing pediatric gastrointestinal bleeding caused by active ulcers.
- To compare TXA with standard endoscopic therapy (epinephrine injection).
Main Methods:
- A randomized controlled trial involving 63 children (aged 1 month to 15 years) with GI bleeding.
- Patients were randomized to receive either topical TXA or submucosal epinephrine injection during endoscopy.
- Both groups received supportive intravenous fluids and proton pump inhibitors.
Main Results:
- No statistically significant difference in rebleeding rates between the TXA (11.4%) and epinephrine (9.8%) groups (P=0.50).
- Trends towards non-significant differences in blood transfusion needs (P=0.06) and hospital stay duration (P=0.07).
Conclusions:
- Topical tranexamic acid (TXA) may be a viable option for endoscopic treatment of bleeding peptic ulcers in children.
- Larger clinical trials are required to definitively establish the therapeutic benefit of topical TXA.
Background:
Peptic ulcers are among the most common causes of upper gastrointestinal (GI) bleeding in children. The standard care for GI bleeding is endoscopy for diagnostic and therapeutic purposes. We aimed to assess the effect of topical tranexamic acid (TXA) via endoscopic procedures in children with GI bleeding caused by bleeding ulcers.
Procedure:
In this randomised controlled trial, 120 children were evaluated by diagnostic procedures for GI bleeding, of which 63 (30 girls, 33 boys) aged 1-month to 15 years were recruited. The patients were randomly divided into case and control groups. In the case group, TXA was administered directly under endoscopic therapy. In the control group, epinephrine (1/10,000) was submucosally injected to the four quadrants of ulcer margins as the routine endoscopic therapy. In both groups, the patients received supportive medical therapy with intravenous fluids and proton pump inhibitor drugs.
Results:
The mean ± standard deviation age of the children was 5 ± 2.03 years. Rebleeding occurred in 15 (11.4%) and 21 (9.8%) patients in the case and control groups, respectively (P = 0.50). The frequency of blood transfusion episodes (P = 0.06) and duration of hospital stay (P = 0.07) were not statistically different between the groups.
Conclusion:
Using topical TXA via endoscopic procedures may be effective in cases of GI bleedings caused by active bleeding ulcers. In order to establish this therapeutic effect, a large number of clinical studies are needed.
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