Intravenous tranexamic acid in gastrointestinal bleeding: A systematic review and meta-analysis of randomized...

Gastrointestinal bleeding is a critical condition associated with high morbidity and mortality, necessitating effective management strategies. Tranexamic acid (TXA), an anti-fibrinolytic agent, has been proposed as a therapeutic option to reduce bleeding complications. However, recent randomized controlled trials (RCTs) have produced conflicting results regarding its efficacy and safety.

This systematic review and meta-analysis followed PRISMA guidelines and included RCTs evaluating the use of intravenous TXA in adult patients with gastrointestinal bleeding. Comprehensive searches were conducted in PubMed and Google Scholar, yielding 518 publications, with 7 RCTs meeting inclusion criteria. Data were synthesized using mainly a random-effects model to assess outcomes, including mortality, rebleeding, failure to control bleeding, thromboembolic events, and blood transfusion requirements.

The analysis included 7 RCTs of 13,608 participants, revealing that IV TXA was statistically significant in reducing rebleeding rates (OR 0.64; 95 % CI: 0.45-0.91, P = 0.01) and failure to control bleeding (OR 0.55; 95 % CI: 0.45-0.91, P = 0.03). However, there was no significant reduction in mortality (OR 0.77; 95 % CI: 0.56-1.07, P = 0.12) or blood transfusion requirements (OR 0.94;95 % CI: 0.61-1.43, P = 0.76). While thromboembolic events showed no significant difference in the random-effects model (OR 1.28; 95 % CI: 0.51-4.51, P = 0.46), fixed-effect analysis suggested a statistical significance (OR 1.28; 95 % CI: 1.07-1.55, P = 0.009).

Intravenous TXA appears to be an effective adjunctive therapy for managing gastrointestinal bleeding, particularly in reducing rebleeding and failure to control bleeding. However, it does not significantly affect mortality rates, and caution is warranted regarding potential thromboembolic risks. Further research is needed to optimize TXA use and identify high-risk populations to enhance patient outcomes in gastrointestinal bleeding management.