Tranexamic Acid in the Management of Non-variceal Upper Gastrointestinal Bleeding
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 manag...
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| Language: | English |
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Interna Publishing
2024-05-01
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| Series: | The Indonesian Journal of Gastroenterology, Hepatology and Digestive Endoscopy |
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| Online Access: | https://ina-jghe.com/index.php/jghe/article/view/948 |
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| author | Muhammad Reza Saskia Aziza Nursyirwan |
| author_facet | Muhammad Reza Saskia Aziza Nursyirwan |
| author_sort | Muhammad Reza |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-53e4120fd2eb4b3284c2d7985d4c9656 |
| institution | OA Journals |
| issn | 1411-4801 2302-8181 |
| language | English |
| publishDate | 2024-05-01 |
| publisher | Interna Publishing |
| record_format | Article |
| series | The Indonesian Journal of Gastroenterology, Hepatology and Digestive Endoscopy |
| spelling | doaj-art-53e4120fd2eb4b3284c2d7985d4c96562025-08-20T02:25:59ZengInterna PublishingThe Indonesian Journal of Gastroenterology, Hepatology and Digestive Endoscopy1411-48012302-81812024-05-01251839310.24871/251202483-93870Tranexamic Acid in the Management of Non-variceal Upper Gastrointestinal BleedingMuhammad Reza0Saskia Aziza Nursyirwan1Faculty of Medicine, Universitas IndonesiaInternal Medicine Department, Cipto Mangunkusumo National General Hospital, Faculty of Medicine, Universitas IndonesiaBackground: 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.https://ina-jghe.com/index.php/jghe/article/view/948non-variceal gastrointestinal bleedingugibtranexamic acidplacebo |
| spellingShingle | Muhammad Reza Saskia Aziza Nursyirwan Tranexamic Acid in the Management of Non-variceal Upper Gastrointestinal Bleeding The Indonesian Journal of Gastroenterology, Hepatology and Digestive Endoscopy non-variceal gastrointestinal bleeding ugib tranexamic acid placebo |
| title | Tranexamic Acid in the Management of Non-variceal Upper Gastrointestinal Bleeding |
| title_full | Tranexamic Acid in the Management of Non-variceal Upper Gastrointestinal Bleeding |
| title_fullStr | Tranexamic Acid in the Management of Non-variceal Upper Gastrointestinal Bleeding |
| title_full_unstemmed | Tranexamic Acid in the Management of Non-variceal Upper Gastrointestinal Bleeding |
| title_short | Tranexamic Acid in the Management of Non-variceal Upper Gastrointestinal Bleeding |
| title_sort | tranexamic acid in the management of non variceal upper gastrointestinal bleeding |
| topic | non-variceal gastrointestinal bleeding ugib tranexamic acid placebo |
| url | https://ina-jghe.com/index.php/jghe/article/view/948 |
| work_keys_str_mv | AT muhammadreza tranexamicacidinthemanagementofnonvaricealuppergastrointestinalbleeding AT saskiaazizanursyirwan tranexamicacidinthemanagementofnonvaricealuppergastrointestinalbleeding |