Efficacy and safety of tranexamic acid in acute upper gastrointestinal bleeding: meta-analysis of randomised controlled trials

Division of Gastroenterology, University of Tennessee Health Science Center, Memphis, TN, USA. Division of Gastroenterology, University of Alabama at Birmingham, Birmingham, AL, USA. Mulford Medical Sciences Library, University of Toledo, Toledo, OH, USA. Department of Medicine, University of Toledo, Toledo, OH, USA. Division of Gastroenterology, William Beaumont Hospital, Royal Oak, MI, USA. Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA. Division of Gastroenterology, Geisinger Medical Center, Danville, PA, USA.

Scandinavian journal of gastroenterology. 2020;:1-8
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PICO Summary

Population

Patients with acute upper gastrointestinal bleeding bleeding (12 studies, n= 14,100).

Intervention

Tranexamic acid (n= 7101).

Comparison

Placebo (n= 6999).

Outcome

No significant difference in mortality, rebleeding, need for surgery, need for transfusion, or thromboembolic events, between treatments was found. However, there was an increased risk of venous thromboembolic events with tranexamic acid.
Abstract
BACKGROUND Studies evaluating the role of tranexamic acid in acute upper GI bleeding (UGIB) have reported conflicting results. In this systematic review, we have evaluated the efficacy and safety of tranexamic acid in UGIB. METHODS We searched several databases from inception to June 6, 2020 to identify randomised controlled trials (RCTs) that compared tranexamic acid and placebo in UGIB. Our outcomes of interest were mortality, rebleeding, all thromboembolic events, venous thromboembolic events, need for transfusion, endoscopic intervention and surgery. Pooled risk ratios (RR) with 95% confidence intervals (CI) were calculated using fixed effect model. We used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework to assess the certainty of evidence. RESULTS We included 12 RCTs comprising 14,100 patients. We found no significant difference in mortality, pooled RR (95% CI) 0.87 (0.74-1.01), rebleeding, pooled RR (95% CI) 0.90 (0.79-1.02), need for surgery, pooled RR (95% CI) 0.86 (0.73-1.02), need for transfusion, pooled RR (95% CI) 1.00 (0.99-1.01) or thromboembolic events, RR (95% CI) 1.16 (0.87-1.56) between treatments. We found an increased risk of venous thromboembolic events with tranexamic acid, pooled RR (95% CI) 1.94 (1.23-3.05). Certainty of evidence based on the GRADE framework for the different outcomes ranged from low to very low. CONCLUSIONS Tranexamic acid does not improve outcomes in UGIB and may increase the risk of venous thromboembolic events.
Study details
Study Design : Systematic Review
Language : eng
Credits : Bibliographic data from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine