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 criteria Randomised 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 1 Tranexamic acid for upper gastrointestinal bleeding (Review)

Tranexamic acid in upper gastrointestinal bleed in patients with cirrhosis: A randomized controlled trial

“…However, considering the internal and external validity of the evidence, tranexamic acid was not recommended for routine use. [7] A 2014 Cochrane meta-analysis (including 8 RCTs) found that tranexamic acid reduced mortality compared with placebo (42 of 851 vs. 71 of 850 patients; RR: 0.60; 95% CI: 0.42-0.87) and rebleeding (117 of 826 vs. 146 of 825 patients; RR: 0.80; 95% CI: 0.64-1.00) in patients with UGIB. However, a high dropout rate in some trials created uncertainty about the results.…”

Tranexamic acid in upper gastrointestinal bleed in patients with cirrhosis: A randomized controlled trial

“…However, considering the internal and external validity of the evidence, tranexamic acid was not recommended for routine use. [7] A 2014 Cochrane meta-analysis (including 8 RCTs) found that tranexamic acid reduced mortality compared with placebo (42 of 851 vs. 71 of 850 patients; RR: 0.60; 95% CI: 0.42-0.87) and rebleeding (117 of 826 vs. 146 of 825 patients; RR: 0.80; 95% CI: 0.64-1.00) in patients with UGIB. However, a high dropout rate in some trials created uncertainty about the results.…”

HALT-IT - tranexamic acid for the treatment of gastrointestinal bleeding: study protocol for a randomised controlled trial

“…Moreover, only three trials reported data on adverse events. Specifically, the risk of thromboembolic events was about 1% overall and may be higher in TXA-treated patients [ 21 ].…”

How effective is tranexamic acid for acute gastrointestinal bleeding?

“…These studies were already included in the previous Cochrane review. 18 The risk of thromboembolic events is about 1% overall and seemed to be higher in TXA treated patients (relative risk 1.86, 0.66 to 5.24). However, the result is imprecise and compatible with the play of chance.…”

Tranexamic acid in upper gastrointestinal bleed in patients with cirrhosis: A randomized controlled trial

“…However, considering the internal and external validity of the evidence, tranexamic acid was not recommended for routine use. [7] A 2014 Cochrane meta-analysis (including 8 RCTs) found that tranexamic acid reduced mortality compared with placebo (42 of 851 vs. 71 of 850 patients; RR: 0.60; 95% CI: 0.42-0.87) and rebleeding (117 of 826 vs. 146 of 825 patients; RR: 0.80; 95% CI: 0.64-1.00) in patients with UGIB. However, a high dropout rate in some trials created uncertainty about the results.…”

HALT-IT - tranexamic acid for the treatment of gastrointestinal bleeding: study protocol for a randomised controlled trial

“…Moreover, only three trials reported data on adverse events. Specifically, the risk of thromboembolic events was about 1% overall and may be higher in TXA-treated patients [ 21 ].…”

How effective is tranexamic acid for acute gastrointestinal bleeding?

“…These studies were already included in the previous Cochrane review. 18 The risk of thromboembolic events is about 1% overall and seemed to be higher in TXA treated patients (relative risk 1.86, 0.66 to 5.24). However, the result is imprecise and compatible with the play of chance.…”

Tranexamic acid in upper gastrointestinal bleed in patients with cirrhosis: A randomized controlled trial

“…However, considering the internal and external validity of the evidence, tranexamic acid was not recommended for routine use. [7] A 2014 Cochrane meta-analysis (including 8 RCTs) found that tranexamic acid reduced mortality compared with placebo (42 of 851 vs. 71 of 850 patients; RR: 0.60; 95% CI: 0.42-0.87) and rebleeding (117 of 826 vs. 146 of 825 patients; RR: 0.80; 95% CI: 0.64-1.00) in patients with UGIB. However, a high dropout rate in some trials created uncertainty about the results.…”

HALT-IT - tranexamic acid for the treatment of gastrointestinal bleeding: study protocol for a randomised controlled trial

“…Moreover, only three trials reported data on adverse events. Specifically, the risk of thromboembolic events was about 1% overall and may be higher in TXA-treated patients [ 21 ].…”

How effective is tranexamic acid for acute gastrointestinal bleeding?

“…These studies were already included in the previous Cochrane review. 18 The risk of thromboembolic events is about 1% overall and seemed to be higher in TXA treated patients (relative risk 1.86, 0.66 to 5.24). However, the result is imprecise and compatible with the play of chance.…”