Background Tranexamic acid reduces surgical bleeding and reduces death due to bleeding in patients with trauma. Meta-analyses of small trials show that tranexamic acid might decrease deaths from gastrointestinal bleeding. We aimed to assess the effects of tranexamic acid in patients with gastrointestinal bleeding. Methods We did an international, multicentre, randomised, placebo-controlled trial in 164 hospitals in 15 countries. Patients were enrolled if the responsible clinician was uncertain whether to use tranexamic acid, were aged above the minimum age considered an adult in their country (either aged 16 years and older or aged 18 years and older), and had significant (defined as at risk of bleeding to death) upper or lower gastrointestinal bleeding. Patients were randomly assigned by selection of a numbered treatment pack from a box containing eight packs that were identical apart from the pack number. Patients received either a loading dose of 1 g tranexamic acid, which was added to 100 mL infusion bag of 0•9% sodium chloride and infused by slow intravenous injection over 10 min, followed by a maintenance dose of 3 g tranexamic acid added to 1 L of any isotonic intravenous solution and infused at 125 mg/h for 24 h, or placebo (sodium chloride 0•9%). Patients, caregivers, and those assessing outcomes were masked to allocation. The primary outcome was death due to bleeding within 5 days of randomisation; analysis excluded patients who received neither dose of the allocated treatment and those for whom outcome data on death were unavailable. This trial was registered with Current Controlled Trials, ISRCTN11225767, and ClinicalTrials.gov, NCT01658124.

(BJOG. 2020;127:478–488) Preeclampsia is associated with maternal and perinatal morbidity, causing 1 in 5 maternal deaths in low-resource countries. While low-dose aspirin has been moderately effective in treating preeclampsia, there is a clear need for a more effective treatment. Elevated circulating levels of soluble fms-like tyrosine kinase-1 (sFlt-1) have been observed in women with preeclampsia. Statins reduce sFlt-1 from cultured cells, and in pregnant animals with a preeclampsia-like syndrome, statins have improved outcomes. This study aimed to investigate the effects of pravastatin 40 mg daily on the clinical condition and maternal plasma sFlt-1 levels in women with early-onset preeclampsia.

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