The Efficacy of Tranexamic Acid in Upper Gastrointestinal Hemorrhage: A Double-Blind Randomized Controlled Trial

Abstract

Background and AimsUpper gastrointestinal haemorrhage is one of the major problems for which patients are brought to the emergency department. Endoscopy is the main diagnostic tool and treatment for upper gastrointestinal haemorrhage. Nevertheless, in regional hospitals, not every patient receives immediate endoscopy. Medical haemostasis might be beneficial during this period. Proton-pump inhibitors (PPIs) and octreotide analogues are widely used and proven useful. Tranexamic acid is an antifibrinolytic agent that is generally prescribed for multiple organ haemostasis. This study aimed to determine whether tranexamic acid administration to upper gastrointestinal haemorrhage patients while waiting for endoscopy aids in improving clinical outcomes, and decreasing mortality and rebleeding risk.MethodsA prospective, double blind, randomized study was performed in patients who encountered upper gastrointestinal haemorrhage at Khon Kaen hospital. Patients were randomized to tranexamic acid or placebo as adjunct to conventional treatment prior to endoscopy. The primary outcome was presence of blood in stomach on endoscopy. The secondary outcomes included mortality rate, rebleeding rate, and need for transfusion.ResultsOne hundred twenty-eight patients were enrolled. After randomization, 63 received tranexamic acid and 65 received placebo. On endoscopy, presence of blood in stomach was found significantly less often in patients receiving tranexamic acid vs placebo (19.0% vs 41.5%; P = .007). Mortality rate, rebleeding rate, need for transfusion, need for surgery and length of stay were not significantly different in the two groups. No in-admission complications were reported in patients receiving tranexamic acid.ConclusionAdministration of tranexamic acid prior to endoscopy reduces the amount of blood retained in the stomach and Results in improved clinical outcomes. Background and AimsUpper gastrointestinal haemorrhage is one of the major problems for which patients are brought to the emergency department. Endoscopy is the main diagnostic tool and treatment for upper gastrointestinal haemorrhage. Nevertheless, in regional hospitals, not every patient receives immediate endoscopy. Medical haemostasis might be beneficial during this period. Proton-pump inhibitors (PPIs) and octreotide analogues are widely used and proven useful. Tranexamic acid is an antifibrinolytic agent that is generally prescribed for multiple organ haemostasis. This study aimed to determine whether tranexamic acid administration to upper gastrointestinal haemorrhage patients while waiting for endoscopy aids in improving clinical outcomes, and decreasing mortality and rebleeding risk. Upper gastrointestinal haemorrhage is one of the major problems for which patients are brought to the emergency department. Endoscopy is the main diagnostic tool and treatment for upper gastrointestinal haemorrhage. Nevertheless, in regional hospitals, not every patient receives immediate endoscopy. Medical haemostasis might be beneficial during this period. Proton-pump inhibitors (PPIs) and octreotide analogues are widely used and proven useful. Tranexamic acid is an antifibrinolytic agent that is generally prescribed for multiple organ haemostasis. This study aimed to determine whether tranexamic acid administration to upper gastrointestinal haemorrhage patients while waiting for endoscopy aids in improving clinical outcomes, and decreasing mortality and rebleeding risk. MethodsA prospective, double blind, randomized study was performed in patients who encountered upper gastrointestinal haemorrhage at Khon Kaen hospital. Patients were randomized to tranexamic acid or placebo as adjunct to conventional treatment prior to endoscopy. The primary outcome was presence of blood in stomach on endoscopy. The secondary outcomes included mortality rate, rebleeding rate, and need for transfusion. A prospective, double blind, randomized study was performed in patients who encountered upper gastrointestinal haemorrhage at Khon Kaen hospital. Patients were randomized to tranexamic acid or placebo as adjunct to conventional treatment prior to endoscopy. The primary outcome was presence of blood in stomach on endoscopy. The secondary outcomes included mortality rate, rebleeding rate, and need for transfusion. ResultsOne hundred twenty-eight patients were enrolled. After randomization, 63 received tranexamic acid and 65 received placebo. On endoscopy, presence of blood in stomach was found significantly less often in patients receiving tranexamic acid vs placebo (19.0% vs 41.5%; P = .007). Mortality rate, rebleeding rate, need for transfusion, need for surgery and length of stay were not significantly different in the two groups. No in-admission complications were reported in patients receiving tranexamic acid. One hundred twenty-eight patients were enrolled. After randomization, 63 received tranexamic acid and 65 received placebo. On endoscopy, presence of blood in stomach was found significantly less often in patients receiving tranexamic acid vs placebo (19.0% vs 41.5%; P = .007). Mortality rate, rebleeding rate, need for transfusion, need for surgery and length of stay were not significantly different in the two groups. No in-admission complications were reported in patients receiving tranexamic acid. ConclusionAdministration of tranexamic acid prior to endoscopy reduces the amount of blood retained in the stomach and Results in improved clinical outcomes. Administration of tranexamic acid prior to endoscopy reduces the amount of blood retained in the stomach and Results in improved clinical outcomes.