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

Burke, Eoghan; Harkins, Patricia; Ahmed, Ibrahim

doi:10.1155/2021/8876991

Cited by 9 publications

(12 citation statements)

References 25 publications

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“…21 Another systematic review found that tranexamic acid had some beneficial effect in terms of decreasing the risk of re-bleeding and decreasing the need for surgery but there wasn't statistically significant effect on mortality or need of blood transfusion or risk of thromboembolic events. 22 According to the available evidence, tranexamic acid is an effective medication for patients with upper gastrointestinal bleeding and early administration of tranexamic acid may be worth be recommended for the treatment of UGIB in the Emergency Department. 23 In an emergency, it is helpful for clinicians to use risk stratification tools to triage patients who need endoscopy in a suitable time frame and patients who are a low risk that can be followed up on an outpatient basis.…”

Section: Resultsmentioning

confidence: 99%

Clinical profile of patients presenting to emergency with upper gastrointestinal bleeding in a tertiary hospital of Nepal

Adhikari

Rijal

House

2021

J Patan Acad Health Sci

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Introduction: Upper gastrointestinal bleeding is an acute emergency condition. It is an important cause for the hospital admission. This study descriptively analyses the clinical profile of upper gastrointestinal bleeding presenting to a tertiary hospital in Nepal. Method: This is a cross-sectional study of patients presenting with upper gastrointestinal bleeding from 01 Oct 2018 to 30 Sep 2019 at Patan Hospital Emergency Department, Patan Academy of Health Sciences, Nepal. Patient’s demographics, clinical presentation, duration of illness before presenting to Emergency, vitals, and laboratory parameters were descriptively analyzed. Ethical approval was obtained. Result: There were 121 patients, male 82(67.8%) and female 38(31.4%) aging 14 to 90 years. Fifty-three patients (43.8 %) presented with hematemesis, 38(31.4%) with melena, and 27(22.3%) with both hematemesis and melena. Variceal bleeding was the main cause of upper gastrointestinal bleeding found in 73(60.33%) followed by ulcer bleeding in 48(39.66%). Conclusion: Variceal bleeding was the main cause of upper gastrointestinal bleeding and hematemesis was the most common clinical presentation in patients presenting to the Emergency Department.

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Section: Resultsmentioning

confidence: 99%

Clinical profile of patients presenting to emergency with upper gastrointestinal bleeding in a tertiary hospital of Nepal

Adhikari

Rijal

House

2021

J Patan Acad Health Sci

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“…Burke et al performed a systemic review of 8 studies that included 12,994 patients with upper gastrointestinal bleeding. Although no effect on mortality was noted, the beneficial effect of TXA on lower rebleeding risk and a decreased need for surgery was observed [ 14 ]. Another systematic review and meta-analysis, including 13 relevant randomized clinical trials and a total of 2271 patients, demonstrated lower mortality and continued bleeding and less need for urgent endoscopic intervention [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

Risk of Mortality among Patients with Gastrointestinal Bleeding with Early and Late Treatment with Tranexamic Acid: A Population-Based Cohort Study

Ting

Shiu

Yang

et al. 2022

JCM

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Tranexamic acid (TXA) is an antifibrinolytic pharmacological agent, but its use in gastrointestinal bleeding remains contentious. Moreover, studies on the timing of TXA administration are limited. We examined whether early TXA administration reduced the risk of mortality in patients with gastrointestinal bleeding in a Taiwanese population. We used the National Health Insurance Research Database to identify patients diagnosed with gastrointestinal bleeding with early and late TXA treatment. We defined early treatment as initial TXA treatment in an emergency department and late treatment as initial TXA treatment after hospitalization. Mortality within 52 weeks was the primary outcome. A multivariable analysis using a multiple Cox regression model was applied for data analysis. Propensity score matching (PSM) was performed to reduce the potential for bias caused by measured confounding variables. Of the 52,949 selected patients with gastrointestinal bleeding, 5127 were assigned to either an early or late TXA treatment group after PSM. The incidence of mortality was significantly decreased during the first and fourth weeks (adjusted HR (aHR): 0.65, 95% CI: 0.56–0.75). A Kaplan–Meier curve revealed a significant decrease in cumulative incidence of mortality in the early TXA treatment group (log-rank test: p < 0.0001). Multiple Cox regression analysis revealed significantly lower mortality in the early TXA treatment group compared with the late treatment group (aHR: 0.64, 95% CI: 0.57–0.73). Thromboembolic events were not significantly associated with early or late TXA treatment (aHR: 1.03, 95% CI: 0.94–1.12). A Kaplan–Meier curve also revealed no significant difference in either venous or arterial events (log-rank test: p = 0.3654 and 0.0975, respectively). In conclusion, early TXA treatment was associated with a reduced risk of mortality in patients with gastrointestinal bleeding compared with late treatment, without an increase in thromboembolic events. The risk of rebleeding and need for urgent endoscopic intervention require further randomized clinical trials.

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“…Although the recommendation for early administration of antifibrinolytics is supported by robust data in adult trauma (17,18) and obstetric (32,43) patients, the benefit of antifibrinolytics in adults with gastrointestinal bleeding is less clear. Despite several meta-analyses that have reported a survival benefit, decreased endoscopic intervention, and decreased bleeding (44,45), the recently published Haemorrhage ALleviation with Tranexamic acid -Intestinal system (HALT-IT) trial found no difference in death due to GI bleeding (46). Compared with trauma and obstetric cohorts, the HALT-IT cohort was substantially older; importantly, the effect of age on the hemostatic response to antifibrinolytics has yet to be investigated.…”

Section: Online Clinical Investigationsmentioning

confidence: 99%

Use of Antifibrinolytics in Pediatric Life-Threatening Hemorrhage: A Prospective Observational Multicenter Study

Spinella

Leonard

Gaines

et al. 2021

Critical Care Medicine

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OBJECTIVES: To assess the impact of antifibrinolytics in children with life-threatening hemorrhage. DESIGN: Secondary analysis of the MAssive Transfusion epidemiology and outcomes In Children study dataset, a prospective observational study of children with life-threatening bleeding events. SETTING: Twenty-four children’s hospitals in the United States, Canada, and Italy. PATIENTS: Children 0–17 years old who received greater than 40 mL/kg of total blood products over 6 hours or were transfused under activation of massive transfusion protocol. Intervention/Exposure: Children were compared according to receipt of antifibrinolytic medication (tranexamic acid or aminocaproic acid) during the bleeding event. MEASUREMENTS AND MAIN RESULTS: Patient characteristics, medications administered, and clinical outcomes were analyzed using Cox proportional hazard and Kaplan-Meier survival analysis. The primary outcome was 24-hour mortality. Of 449 patients analyzed, median age was 7 years (2–15 yr), and 55% were male. The etiology of bleeding was 46% traumatic, 34% operative, and 20% medical. Twelve percent received antifibrinolytic medication during the bleeding event (n = 54 unique subjects; n = 18 epsilon aminocaproic acid, n = 35 tranexamic acid, and n = 1 both). The antifibrinolytic group was comparable with the nonantifibrinolytic group on baseline demographic and physiologic parameters; the antifibrinolytic group had longer massive transfusion protocol duration, received greater volume blood products, and received factor VII more frequently. In the antifibrinolytic group, there was significantly less 6-hour mortality overall (6% vs 17%; p = 0.04) and less 6-hour mortality due to hemorrhage (4% vs 14%; p = 0.04). After adjusting for age, bleeding etiology, Pediatric Risk of Mortality score, and plasma deficit, the antifibrinolytic group had decreased mortality at 6- and 24-hour postbleed (adjusted odds ratio, 0.29 [95% CI, 0.09–0.93]; p = 0.04 and adjusted odds ratio, 0.45 [95% CI, 0.21–0.98]; p = 0.04, respectively). CONCLUSIONS: Administration of antifibrinolytic medications during the life-threatening event was independently associated with improved 6- and 24-hour survivals in bleeding children. Consideration should be given to use of antifibrinolytics in pediatric patients with life-threatening hemorrhage.

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

Cited by 9 publications

References 25 publications

Clinical profile of patients presenting to emergency with upper gastrointestinal bleeding in a tertiary hospital of Nepal

Clinical profile of patients presenting to emergency with upper gastrointestinal bleeding in a tertiary hospital of Nepal

Risk of Mortality among Patients with Gastrointestinal Bleeding with Early and Late Treatment with Tranexamic Acid: A Population-Based Cohort Study

Use of Antifibrinolytics in Pediatric Life-Threatening Hemorrhage: A Prospective Observational Multicenter Study

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