Is There a Role for Tranexamic Acid in Upper GI Bleeding? A Systematic Review and Meta-Analysis

Area of Science:

• Gastroenterology
• Pharmacology
• Critical Care Medicine

Background:

• Upper gastrointestinal (GI) bleeding presents significant morbidity and mortality risks.
• Tranexamic acid (TXA), an antifibrinolytic, is approved for trauma hemorrhage but its role in upper GI bleeding is not established.
• Current guidelines do not recommend TXA for upper GI bleeding management.

Purpose of the Study:

• To synthesize existing evidence on the efficacy of tranexamic acid (TXA) in managing upper GI bleeding.
• To evaluate the impact of TXA on key outcomes including mortality, re-bleeding, need for surgery, and thromboembolic events.

Main Methods:

• A systematic review of relevant studies was conducted.
• Searches were performed across PubMed, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL).
• A random effects meta-analysis was employed to determine risk ratios for primary and secondary outcomes.

Main Results:

• The meta-analysis included 8 studies with 12,994 patients.
• TXA significantly reduced the risk of re-bleeding (RR 0.64, 95% CI 0.47-0.86) and the need for surgery (RR 0.59, 95% CI 0.38-0.94).
• No statistically significant effects were observed for mortality (RR 0.95, 95% CI 0.80-1.13) or adverse thromboembolic events (RR 0.93, 95% CI 0.62-1.39).

Conclusions:

• Tranexamic acid (TXA) demonstrates a potential benefit in reducing re-bleeding rates and surgical intervention in upper GI bleeding.
• The current evidence does not support a significant impact of TXA on mortality or the risk of thromboembolic events.
• Further randomized controlled trials are needed to clarify the effects of TXA on these outcomes.