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Meta-Analysis
. 2022 Mar 1;50(3):e313-e319.
doi: 10.1097/CCM.0000000000005362.

Tranexamic Acid in Gastrointestinal Bleeding: A Systematic Review and Meta-Analysis

Joanna C Dionne  1   2   3 , Simon J W Oczkowski  1   2   3 , Beverley J Hunt  4   5 , Massimo Antonelli  6   7 , Marije Wijnberge  8   9 , Senta Jorinde Raasveld  9 , Alexander P J Vlaar  9 ; for ESICM Transfusion Taskforce and the GUIDE Group
Affiliations
Meta-Analysis

Tranexamic Acid in Gastrointestinal Bleeding: A Systematic Review and Meta-Analysis

Joanna C Dionne et al. Crit Care Med. .

Abstract

Objectives: Tranexamic acid is proposed as a treatment for gastrointestinal bleeding. The Haemorrhage Alleviation with Tranexamic Acid-Intestinal System trial evaluated extended-use (24 hr) high-dose tranexamic acid, prompting a reappraisal for tranexamic acid in gastrointestinal bleeding.

Data sources: We conducted a systematic review and meta-analysis of randomized controlled trials comparing tranexamic acid with usual care or placebo in adults with gastrointestinal bleeding. We searched MEDLINE, EMBASE, and CENTRAL (inception to September 2019).

Data selection: Two reviewers independently screened citations, extracted data, and assessed the risk of bias using the Cochrane risk of bias tool in duplicate. The main outcomes were mortality, bleeding, and adverse events.

Data extraction: Studies were analyzed as high-dose IV tranexamic acid versus all other dosing strategies for tranexamic acid using fixed-effects models. We assessed certainty of evidence using the Grading of Recommendations Assessment, Development, and Evaluation approach.

Data synthesis: Five randomized controlled trials evaluated extended-use high-dose IV tranexamic acid, seven evaluating low-dose IV or enteral tranexamic acid. Extended-use high-dose IV tranexamic acid did not reduce mortality (relative risk, 0.98%; 95% CI, 0.88-1.09; I2 = 63%; high certainty) or bleeding (relative risk, 0.92; 95% CI, 0.82-1.04; p = 0.17 and absolute risk differences, -0.7%; 95% CI, -1.5 to 0.3; high certainty) but resulted in a small increase in deep venous thrombosis (relative risk, 2.01; 95% CI, 1.08-3.72; I2 = 0%), pulmonary embolism (relative risk, 1.78; 95% CI, 1.06-3.0; I2 = 0%), and seizure (relative risk, 1.73; 95% CI, 1.03-2.93) with high certainty. Low-dose IV/enteral tranexamic acid did not reduce mortality (relative risk, 0.62; 95% CI, 0.36-1.09; I2 = 0%) but did reduce risk of rebleeding (relative risk, 0.5; 95% CI, 0.33-0.75; I2 = 9%) and need for surgery (relative risk, 0.58; 95% CI, 0.38-0.88; I2 = 11%), with moderate certainty.

Conclusions: Extended-use high-dose IV tranexamic acid does not improve mortality or bleeding outcomes and increases adverse events. Low-dose/enteral tranexamic acid may be effective in reducing hemorrhage; more evidence is required to demonstrate its safety.

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Conflict of interest statement

Dr. Oczkowski received payment as a methodology consultant for the American Thoracic Society. The remaining authors have disclosed that they do not have any potential conflicts of interest.

References

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    1. Shakur H, Roberts I, Fawole B, et al.: Effect 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
    1. Sprigg N, Flaherty K, Appleton JP, et al.; TICH-2 Investigators: Tranexamic acid for hyperacute primary intracerebral haemorrhage (TICH-2): An international randomised, placebo-controlled, phase 3 superiority trial. Lancet. 2018; 391:2107–2115

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