Introduction: Acute upper GI bleeding (UGIB) can have a fatality rate of approximately 10% in severe cases. Tranexamic acid (TXA) prevents fibrinolysis and is utilized in surgical setting to prevent trauma bleeding. The use of TXA in acute UGIB has been evaluated in numerous studies but without conclusive evidence on its mortality benefits. We conducted a systematic review and meta-analysis of studies comparing the use of TXA vs no TXA in patients presenting with acute UGIB.
Methods: We performed a comprehensive search of the databases: PubMed/MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials from inception through May 15th, 2022. We considered randomized controlled trials. We excluded abstracts, animal studies, case reports, case series, reviews, editorials, and letters to editors. The primary outcome was the all-cause of mortality rate. The secondary outcomes were the refractory bleeding and the need of endoscopic intervention. The random-effects model was used to calculate the risk ratios (RR) and 95% confidence intervals (CI). A p value < 0.05 was considered statistically significant. Heterogeneity was assessed using the Higgins I2 index.
Results: Twelve randomized controlled trials involving 14,100 patients were included in the meta-analysis. Eleven studies compared the mortality rate which was significantly lower in patients who were given TXA compared to the no TXA group (4.6% vs 5.3%, RR 0.73, 95% CI 0.58-0.93, p=0.01, I2 = 17%) (Figure 1a). The rate of refractory bleeding was also lower in the TXA group compared to the no TXA group (10.6% vs 21.1%, RR 0.57, 95% CI 0.37-0.87, p =0.009, I2 = 43%) (Figure 1b). However, there was no statistical significance in the rate of requiring endoscopic intervention between the TXA and the no TXA groups (40.3% vs 42.5%, RR 0.95, 95% CI 0.75-1.20, p =0.67, I2 =23%) (Figure 1c).
Discussion: Our meta-analysis demonstrated that the all-cause mortality rate was significantly lower in the patients with acute UGIB who received TXA. Moreover, the rate of refractory UGIB was lower in patients who were given TXA. TXA maybe utilized clinically in patients presenting with UGIB.
