Endoscopic Application of Tranexamic Acid and Sucralfate in Upper Gastrointestinal Bleeding: A Randomized Controlled...

Upper gastrointestinal bleeding (UGIB) is a potentially life-threatening condition. Although standard endoscopic therapies are effective, cases involving tumor-related bleeding or bleeding sites that are challenging to approach remain difficult to manage and are associated with elevated rates of rebleeding. Tranexamic acid (TXA), an antifibrinolytic agent, enhances hemostasis, whereas sucralfate, an antiulcer medication, creates a protective barrier over mucosal injuries. This study evaluated whether the topical application of TXA and sucralfate could reduce the rebleeding rate.

This single-center, prospective, randomized controlled trial included patients with nonvariceal UGIB who received endoscopic hemostasis. All patients received standard endoscopic therapy. Subsequently, participants were randomly assigned to either standard group or intervention group. Those in the intervention group were treated with an additional endoscopic spray containing 1 g of TXA and 2 g of sucralfate. An additional 1 g of barium sulfate was applied as a radiopaque marker to evaluate the powder retaining time. All participants were monitored for 30 days to evaluate the incidence of rebleeding.

Each group included 30 patients, with comparable baseline characteristics between them. The intervention group demonstrated a significantly lower 28-day rebleeding rate compared with the standard therapy group (10.0% vs 36.7%, P = 0.030).In addition, bleeding-free survival was significantly prolonged in the intervention group ( P = 0.018). Furthermore, the study found that the powder remained at the bleeding site for approximately 8-12 hours.

Topical application of TXA and sucralfate during endoscopy is safe and potentially effective in reducing 28-day rebleeding for UGIB. This study was registered at ClinicalTrials.gov (NCT06421389).