Tranexamic acid for upper gastrointestinal bleeding

Abstract

Background Tranexamic acid reduces haemorrhage through its antifibrinolytic effects. In a previous version of the present review, we found that tranexamic acid may reduce mortality. This review includes updated searches and new trials.Objectives To assess the effects of tranexamic acid versus no intervention, placebo or other antiulcer drugs for upper gastrointestinal bleeding.Search methods We updated the review by performing electronic database searches (Cochrane Central Register of Controlled Trials (CENTRAL),MEDLINE, EMBASE, Science Citation Index) and manual searches in July 2014.Selection criteriaRandomised controlled trials, irrespective of language or publication status.Data collection and analysis We used the standard methodological procedures of the The Cochrane Collaboration. All-cause mortality, bleeding and adverse events were the primary outcome measures. We performed fixed-effect and random-effects model meta-analyses and presented results as risk ratios (RRs) with 95% confidence intervals (CIs) and used I² as a measure of between-trial heterogeneity. We analysed tranexamic acid versus placebo or no intervention and tranexamic acid versus antiulcer drugs separately. To analyse sources of heterogeneity and robustness of the overall results, we performed subgroup, sensitivity and sequential analyses.Main results We included eight randomised controlled trials on tranexamic acid for upper gastrointestinal bleeding. Additionally, we identified one large ongoing pragmatic randomised controlled trial from which data are not yet available. Control groups were randomly assigned to placebo (seven trials) or no intervention (one trial). Two trials also included a control group randomly assigned to antiulcer drugs(lansoprazole or cimetidine). The included studies were published from 1973 to 2011. The number of participants randomly assigned ranged from 47 to 216 (median 204). All trials reported mortality. In total, 42 of 851 participants randomly assigned to tranexamic acid and 71 of 850 in the control group died (RR 0.60, 95% CI 0.42 to 0.87; P value 0.007; I² = 0%). The analysis was not confirmed when all participants in the intervention group with missing outcome data were included as treatment failures, or when the analysis was limited to trials with low risk of attrition bias. Rebleeding was diagnosed for 117 of 826 participants in the tranexamic acid group and for 146 of 825 participants in the control group (RR 0.80, 95% CI 0.64 to 1.00; P value 0.07; I² = 49%).We were able to evaluate the risk of serious adverse events on the basis of only four trials. Our analyses showed 'no evidence of a difference between tranexamic acid and control interventions regarding the risk of thromboembolic events.’ Tranexamic acid appeared to reduce the risk of surgery ina fixed-effect meta-analysis (RR 0.73, 95% CI 0.56 to 0.95), but this result was no longer statistically significant in a random-effects meta-analysis (RR 0.61, 95% CI 0.35 to 1.04; P value 0.07). No difference was apparent between tranexamic acid and pla...

Diagnosis and management of acute lower gastrointestinal bleeding: guidelines from the British Society of Gastroenterology

“…There is some evidence for its benefit in acute GI bleeding. Several trials of tranexamic acid in UGIB have been carried out,125 which on pooled analysis showed a 40% risk reduction in mortality 126. However, this treatment benefit for mortality was no longer apparent when the analysis was limited to trials at low risk of bias.…”

Hematological Issues in Liver Disease

“…A Cochrane review has found benefit in use of tranexamic acid (TXA) in upper gastrointestinal bleeding. 50 Similarly, a meta-analysis of randomized controlled trials found the use of TXA in liver transplantation to be safe and effective. 51 With little risk and the potential for benefit, the use of TXA in patients with liver disease and clinically significant bleeding, antifibrinolytics should be considered.…”

Systematic Review and Net-Work Meta-Analysis of Upper Gastrointestinal Hemorrhage Interventions

“…Tranexamic acid is able to bind with receptors on both plasminogen and plasmin and it can act as an antifibrinolytic factor. As suggested by other studies, tranexamic acid is potentially effective for managing gastrointestinal hemorrhage [9].…”