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

Eoghan Burke,Patricia Harkins,Ibrahim Ahmed,Miltiadis I Matsagkas

doi:10.1155/2021/8876991

Abstract

Introduction Upper gastrointestinal (GI) bleeding is associated with increased morbidity and mortality. Tranexamic acid (TXA) is an antifibrinolytic agent which is licensed in the management of haemorrhage associated with trauma. It has been suggested that tranexamic acid may be able to play a role in upper GI bleeding. However, there is currently no recommendation to support this. Aim The aim of this study was to synthesise available evidence of the effect of TXA on upper GI bleeding. Methods and Materials A systematic review was conducted. PubMed, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL) were searched for relevant studies. A random effects meta-analysis was performed to determine the risk ratio of primary and secondary outcomes pertaining to the use of TXA in upper GI bleeding. Results A total of 8 studies were included in this systematic review. The total number of patients in all studies was 12994 including 4550 females (35%) and 8444 males (65%). The mean age of participants in 6 of the studies was 59.3; however the mean age for either intervention or placebo group was not reported in two of the studies. All studies reported on the effect of TXA on mortality, and the risk ratio was 0.95; however, with the 95% CI ranging from 0.80 to 1.13, this was not statistically significant. 6 of the studies reported on rebleeding rate, the risk ratio was 0.64, and with a 95% CI ranging from 0.47 to 0.86, this was statistically significant. 3 of the studies reported on the risk of adverse thromboembolic events, and the risk ratio was 0.93; however, the 95% CI extended from 0.62 to 1.39 and so was not statistically significant. 7 of the studies reported on the need for surgery, and the risk ratio was 0.59 and was statistically significant with a 95% CI ranging from 0.38 to 0.94. Conclusion In conclusion, the use of TXA in upper GI bleeding appears to have a beneficial effect in terms of decreasing the risk of re-bleeding and decreasing the need for surgery. However, we could not find a statistically significant effect on need for blood transfusions, risk of thromboembolic events, or effect on mortality. Future randomised controlled trials may elucidate these outcomes.

Highlights

Upper gastrointestinal (GI) bleeding is associated with increased morbidity and mortality
E majority of upper GI bleeding cases globally are associated with peptic ulcer disease (PUD); this incidence is decreasing globally secondary to the widespread eradication of Helicobacter pylori (H. pylori) with triple therapy
Key words and MeSH terms relating to tranexamic acid and upper GI bleeding were used to develop the search string: ((tranexamic acid) OR (TXA)) AND ((upper gastrointestinal bleeding) OR OR UGIB). is search string was applied to the bibliographic databases on 22nd June 2019: PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials (CENTRAL). is combination of bibliographic databases was chosen based on the findings by Bramer et al [10] on the optimum database combinations to be searched for a systematic review

Summary

Introduction

Upper gastrointestinal (GI) bleeding is associated with increased morbidity and mortality. Tranexamic acid (TXA) is an antifibrinolytic agent which is licensed in the management of haemorrhage associated with trauma. It has been suggested that tranexamic acid may be able to play a role in upper GI bleeding. Aim. e aim of this study was to synthesise available evidence of the effect of TXA on upper GI bleeding. A random effects meta-analysis was performed to determine the risk ratio of primary and secondary outcomes pertaining to the use of TXA in upper GI bleeding. A total of 8 studies were included in this systematic review. E majority of upper GI bleeding cases globally are associated with peptic ulcer disease (PUD); this incidence is decreasing globally secondary to the widespread eradication of Helicobacter pylori (H. pylori) with triple therapy. Other commonly encountered aetiologies include oesophagitis (infectious, inflammatory, eosinophilic, reflux), gastritis (with or without H. pylori as an aetiological factor), vascular abnormalities (Dieulafoy lesions, Gastric Antral Vascular Ectasia), and variceal bleeding [4].

Methods

Results

Conclusion