Tranexamic acid for gastrointestinal bleeding: A systematic review with meta-analysis of randomized clinical trials.
The American journal of emergency medicine · 2020-08-29 · Meta-analysis
Abstract
BACKGROUND: Acute gastrointestinal bleeding is a common life-threatening emergent condition. Immediate tranexamic acid is useful for reducing hemorrhage following operation and bleeding trauma, but evidence on the effects of tranexamic acid in patients with gastrointestinal bleeding is limited or highly heterogeneous. It is still unclear about using tranexamic acid in the emergent condition of gastrointestinal bleeding. This study, therefore, aimed to determine whether or not tranexamic acid should be used in gastrointestinal bleeding management through systematic review and meta-analysis. METHODS: We searched three biomedical databases for relevant randomized controlled trials on this topic. Two authors independently selected studies and extracted data for bias assessment and meta-analysis of bleeding, further intervention, mortality, transfusion, and intensive care unit admission. Available data were pooled using a random-effects model, and the results were presented as risk ratios (RRs) with 95% confidence intervals (CIs). Heterogeneity and small study effects were also assessed. RESULTS: Thirteen randomized controlled trials (n = 2271) were included in the present synthesis. Our meta-analysis revealed that tranexamic acid significantly reduced the rates of continued bleeding (RR = 0.60; 95%CI, 0.43-0.84), urgent endoscopic intervention (RR = 0.35; 95%CI, 0.24-0.50), and mortality (RR = 0.60; 95%CI, 0.45-0.80) compared with the placebo. CONCLUSION: According to the available evidence, the present synthesis confirms that tranexamic acid is an effective medication for patients with upper gastrointestinal bleeding. Early administration of tranexamic acid may be worth to be recommended for treating upper gastrointestinal bleeding in the emergency department. However, the effects of tranexamic acid on lower gastrointestinal bleeding warrant further clarification.
Abstract © the authors or publisher, via PubMed. Reuse and removal
Tags
Haemostatics · Mortality & survival · Tranexamic acid
Related articles
- A high-dose 24-hour tranexamic acid infusion for the treatment of significant gastrointestinal bleeding: HALT-IT RCT. (Health Technol Assess, 2021)
- Effects of a high-dose 24-h infusion of tranexamic acid on death and thromboembolic events in patients with acute gastrointestinal bleeding (HALT-IT): an international randomised, double-blind, placebo-controlled trial. (Lancet, 2020)
- Clinical outcomes of hemostatic interventions in patients with traumatic injury: A systematic review of randomized controlled trials. (J Trauma Acute Care Surg, 2026)
- Comparative efficacy of prehospital resuscitation strategies on mortality for patients with major trauma: a network meta-analysis. (Eur J Emerg Med, 2026)
- The use of tranexamic acid in the management of injured patients at risk of hemorrhage: a systematic review and meta-analysis and an Eastern Association for the Surgery of Trauma Practice Management Guideline. (J Trauma Acute Care Surg, 2025)
- Effect of tranexamic acid on children with traumatic bleeding: A systematic review and meta-analysis. (Am J Emerg Med, 2025)