Tranexamic Acid in the Management of Non-variceal Upper Gastrointestinal Bleeding

Muhammad Reza(1), Saskia Aziza Nursyirwan(2),


(1) Faculty of Medicine, Universitas Indonesia
(2) Internal Medicine Department, Cipto Mangunkusumo National General Hospital, Faculty of Medicine, Universitas Indonesia
Corresponding Author

Abstract


Background: Non-variceal upper gastrointestinal bleeding (UGIB) is a common case of emergency in daily clinical practice with a fairly high mortality rate. The use of tranexamic acid, which has been recommended in managing trauma bleeding, may serve as an alternative pharmacological therapy to manage bleeding in non-variceal UGIB. This evidence-based case report aims to evaluate the impact of tranexamic acid on managing bleeding, risk of mortality, and thromboembolic event in non-variceal UGIB patients.

Methods: A systematic literature search was conducted on 4 databases: CDSR, EMBASE, PubMed, and Scopus for meta-analyses. Studies were selected based on inclusion and exclusion criteria formulated a-priori with subsequent critical appraisal according to the OCEBM critical appraisal tools.

Result: Meta analyses by Kamal, et al (2020) and Twum-Barimah, et al (2020) were included in our report. Kamal, et al shows no significant difference in mortality in tranexamic acid use compared to placebo (RR 0.84; 95%CI 0.63–1.11; I2=2%). Similarly, although Twum-Barimah reported tranexamic acid reduced risk of mortality compared to placebo (RR 0.45; 95%CI 0.23–0.88; p=0.02; I2 = 0%), none of the RCTs included shows significant result when observed individually. In addition, Kamal, et al also reported increased risk of vein thromboembolic events in high-dose tranexamic acid administration (RR 2.21; 95%CI 1.32–3.69; I2=0%) compared to low-dose administration, in UGIB patients.

Conclusion: Tranexamic acid is not recommended to be used in managing bleeding in patients non-variceal UGIB patients and may increase the risk of thromboembolic event.


Keywords


Non-variceal gastrointestinal bleeding; UGIB; tranexamic acid; placebo

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DOI: 10.24871/251202483-93

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