How effective is tranexamic acid for acute gastrointestinal bleeding?

Acute gastrointestinal bleeding is a common emergency. It encompasses upper gastrointestinal bleeding (such as from peptic ulcers and oesophageal varices)1 and lower gastrointestinal bleeding (commonly from diverticular disease, colitis, and cancer).2 The risk is greater in older adults, and many cases are associated with the use of non-steroidal anti-inflammatory drugs.3

In the UK acute gastrointestinal bleeding accounts for about 75 000 hospital admissions each year and has a case fatality of about 10%.3 4 Case fatality may be higher in patients already hospitalised for another condition.1 More effective treatments for acute gastrointestinal bleeding are needed.

Tranexamic acid (TXA) reduces clot breakdown by inhibiting the action of plasmin, which is involved in fibrinolysis. A systematic review of randomised controlled trials in surgical patients shows that TXA, given before or during surgery, reduces the probability of receiving a blood transfusion by about a third (relative risk 0.62, 95% confidence interval 0.58 to 0.65).5 The effect of tranexamic acid on thromboembolic events such as myocardial infarction, stroke, deep vein thrombosis, and pulmonary embolism, however, was uncertain.5

The CRASH-2 trial showed that administration of TXA to bleeding trauma patients reduced death due to bleeding (relative risk 0.85, 0.76 to 0.96) and all cause mortality (relative risk 0.91, 0.85 to 0.97) with no apparent increase in thromboembolic events.6 Among patients treated soon after injury, the reduction in mortality with TXA was even greater.7

The knowledge that TXA reduces bleeding in surgery and reduces mortality in trauma …