INTRODUCTION: 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.
METHOD: 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.
RESULT: 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).
CONCLUSION: 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.
| Specialty Area | Score |
|---|---|
| Hospital Doctor/Hospitalists | |
| Internal Medicine | |
| Emergency Medicine | |
| Gastroenterology |
This study was widely promoted on social media and the results align with the recent RCT findings of no late benefit. While it may be an adjunct in management, it is not the silver bullet that it was for trauma - the effect appears to be different, not just related to bleeding per se.
Although the search in databases was limited (Pubmed and Google Scholar, and exclusively for documents in English) and all types of digestive bleeding were considered together without differentiating origin, prognosis (esophageal varicose veins or peptic ulcers) or severity, the data suggests that TXA could be a potentially effective option to consider in the management of digestive bleeding, without increasing the risk for thromboembolic phenomena.
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