Tranexamic acid for severe gastrointestinal bleeding
Authors: Anders Perner, Morten Hylander Møller
Journal: The Lancet (2020)

Severe gastrointestinal bleeding is frequent and associated with use of blood products and endoscopic and invasive procedures, including emergency surgery, which increases the risk of mortality. 1 Lau JY Barkun A Fan DM Kuipers EJ Yang YS Chan FK Challenges in the management of acute peptic ulcer bleeding. Lancet. 2013; 381: 2033-2043 Summary Full Text Full Text PDF PubMed Scopus (148) Google Scholar Interventions to stop bleeding include the use (often in an escalating manner) of proton-pump inhibitors, transfusion of blood products, therapeutic endoscopy, endovascular coiling, and open laparotomy. 1 Lau JY Barkun A Fan DM Kuipers EJ Yang YS Chan FK Challenges in the management of acute peptic ulcer bleeding. Lancet. 2013; 381: 2033-2043 Summary Full Text Full Text PDF PubMed Scopus (148) Google Scholar , 2 Barkun AN Almadi M Kuipers EJ et al. Management of nonvariceal upper gastrointestinal bleeding: guideline recommendations from the international consensus group. Ann Intern Med. 2019; (published online Oct 22.)DOI:10.7326/M19-1795 Crossref PubMed Scopus (185) Google Scholar Tranexamic acid is also used in some patients in an attempt to inhibit blood clot breakdown by fibrinolysis that can occur in some cases. 3 Adamsen S Bendix J Kallehave F Moesgaard F Nilsson T Wille-Jorgensen P Clinical practice and evidence in endoscopic treatment of bleeding peptic gastroduodenal ulcer. Scand J Gastroenterol. 2007; 42: 318-323 Crossref PubMed Scopus (12) Google Scholar The use of tranexamic acid is supported by data from randomised trials and systematic reviews in patient groups with other conditions, including major trauma, 4 CRASH-2 Trial CollaboratorsEffects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomised, placebo-controlled trial. Lancet. 2010; 376: 23-32 Summary Full Text Full Text PDF PubMed Scopus (2109) Google Scholar post-partum haemorrhage, 5 WOMAN Trial CollaboratorsEffect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial. Lancet. 2017; 389: 2105-2116 Summary Full Text Full Text PDF PubMed Scopus (720) Google Scholar and surgery, 6 Myles PS Smith JA Forbes A et al. Tranexamic acid in patients undergoing coronary-artery surgery. N Engl J Med. 2017; 376: 136-148 Crossref PubMed Scopus (197) Google Scholar in whom the use of tranexamic acid reduces mortality or bleeding with few adverse events. In patients with severe gastrointestinal bleeding, the evidence for the benefit of tranexamic acid has been unclear because existing data have come from few and small randomised trials, most of which had a high risk of bias. 7 Bennett C Klingenberg SL Langholz E Gluud LL Tranexamic acid for upper gastrointestinal bleeding. Cochrane Database Syst Rev. 2014; 2014CD006640 Google Scholar 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 trialWe found that tranexamic acid did not reduce death from gastrointestinal bleeding. On the basis of our results, tranexamic acid should not be used for the treatment of gastrointestinal bleeding outside the context of a randomised trial. Full-Text PDF Open Access