Systematic review: tranexamic acid for upper gastrointestinal bleeding
Article first published online: 4 FEB 2008
© 2008 The Authors
Alimentary Pharmacology & Therapeutics
Volume 27, Issue 9, pages 752–758, May 2008
How to Cite
GLUUD, L. L., KLINGENBERG, S. L. and LANGHOLZ, S. E. (2008), Systematic review: tranexamic acid for upper gastrointestinal bleeding. Alimentary Pharmacology & Therapeutics, 27: 752–758. doi: 10.1111/j.1365-2036.2008.03638.x
- Issue published online: 4 FEB 2008
- Article first published online: 4 FEB 2008
- Publication data Submitted 15 November 2007 First decision 29 November 2007 Resubmitted 30 January 2008 Accepted 31 January 2008 Epub OnlineAccepted 4 February 2008
Background Tranexamic acid may reduce upper gastrointestinal bleeding and stabilize patients before endoscopic treatments.
Aim To review randomized trials on tranexamic acid for upper gastrointestinal bleeding.
Methods Manual and electronic searches of The Cochrane Library, MEDLINE, EMBASE and Science Citation Index were combined. Intention-to-treat random effect meta-analyses were performed and results presented as RRs with 95% confidence intervals.
Results Seven double-blind randomized trials on tranexamic acid vs. placebo were included. Of 1754 patients randomized, 21% were excluded. Only one trial included endoscopic treatments or proton pump inhibitors. Five per cent of patients on tranexamic acid and 8% of controls died (RR: 0.61, 95% CI: 0.42–0.89). No significant differences were found on bleeding, bleeding-related mortality, surgery or transfusion requirements. Adverse events were unclearly reported. Data from three of the included trials suggested that tranexamic acid did not significantly increase the risk of thromboembolic disease.
Conclusions The present review suggests that tranexamic acid may reduce all-cause mortality. However, because of limitations in the internal and external validity of included trials, additional evidence is needed before treatment recommendations can be made.