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Meta-Analysis
. 2024 Apr;193(2):705-719.
doi: 10.1007/s11845-023-03517-0. Epub 2023 Oct 4.

A systematic review and meta-analysis assessing the use of tranexamic acid (TXA) in acute gastrointestinal bleeding

Oisín O'Donnell  1   2 , Clodagh Gallagher  3 , Matthew G Davey  4   5 , Jonathan Coulter  4 , Mark Regan  4
Affiliations
Meta-Analysis

A systematic review and meta-analysis assessing the use of tranexamic acid (TXA) in acute gastrointestinal bleeding

Oisín O'Donnell et al. Ir J Med Sci. 2024 Apr.

Abstract

Introduction: Gastrointestinal bleeding results in significant morbidity, cost and mortality. TXA, an antifibrinolytic agent, has been proposed to reduce mortality; however, many studies report conflicting results.

Methods: The aim of the study was to perform the first systematic review and meta-analysis of RCTs to evaluate the efficacy TXA for both upper and lower gastrointestinal bleeding. This was performed per PRISMA guidelines. PubMed, EMBASE, Cochrane and Scopus databases were searched for RCTs. Dichotomous variables were pooled as risk ratios (RR) with 95% confidence intervals (CI) using the MH method with random effects modelling.

Results: Fourteen RCTs were identified with 14,338 patients and mean age of 58.4 years. 34.9% (n = 5008) were female and 65.1% (n = 9330) male. There was no significant difference in mortality between TXA and placebo (RR 0.86 95% CI (0.74 to 1.00), P: 0.05). The secondary outcomes, similarly, did not yield significant results. These included rebleeding, need for surgical intervention (RR: 0.75 95% CI (0.53, 1.07)), endoscopic intervention (RR: 0.92 95% CI (0.70, 1.22)), transfusion requirement (RR: 1.01 95% CI (0.94, 10.7)) and length of stay (RR: 0.03 95% CI (- 0.03, 0.08)). There was no increased risk of VTE, RR: 1.29 95% CI (0.53, 3.16). One trial (n = 12,009) reported an increased risk of seizure in the TXA group, RR: 1.73 95% CI (1.03-2.93).

Conclusion: TXA does not reduce mortality in patients with acute upper or lower gastrointestinal bleeding and may confer an increased risk of seizures. The authors do not recommend the use of TXA in acute gastrointestinal bleeding.

Keywords: Gastrointestinal bleeding; LGIB; Systematic review and meta-analysis; TXA; Tranexamic acid; UGIB.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Meta-analysis forest plot assessing the effect of TXA versus placebo on mortality
Fig. 2
Fig. 2
Meta-analysis forest plot assessing the effect of TXA versus placebo on rebleeding
Fig. 3
Fig. 3
Meta-analysis forest plot assessing the effect of TXA versus placebo on the need for intervention
Fig. 4
Fig. 4
Meta-analysis forest plot assessing the effect of TXA versus placebo on the need for therapeutic endoscopic intervention
Fig. 5
Fig. 5
Meta-analysis forest plot assessing the effect of TXA versus placebo on the need for surgical intervention
Fig. 6
Fig. 6
Meta-analysis forest plot assessing the effect of TXA versus placebo on transfusion requirement
Fig. 7
Fig. 7
Meta-analysis forest plot assessing the effect of TXA versus placebo on transfusion volume
Fig. 8
Fig. 8
Meta-analysis forest plot assessing the effect of TXA versus placebo on overall length of stay
Fig. 9
Fig. 9
Meta-analysis forest plot assessing the effect of TXA versus placebo on ICU length of stay
Fig. 10
Fig. 10
Meta-analysis forest plot assessing the effect of TXA versus placebo on venous thromboembolic events
Fig. 11
Fig. 11
Meta-analysis forest plot assessing the effect of tranexamic acid versus placebo on arterial thromboembolic events
Fig. 12
Fig. 12
Subgroup meta-analysis of TXA versus placebo on mortality in upper and lower GI bleeding
Fig. 13
Fig. 13
Subgroup meta-analysis of TXA versus placebo on mortality in non-variceal and variceal bleeding
See this image and copyright information in PMC

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