TY - JOUR
T1 - Efficacy and safety of tranexamic acid in acute upper gastrointestinal bleeding
T2 - meta-analysis of randomised controlled trials
AU - Kamal, Faisal
AU - Khan, Muhammad Ali
AU - Lee-Smith, Wade
AU - Sharma, Sachit
AU - Imam, Zaid
AU - Jowhar, Dawit
AU - Petryna, Ellen
AU - Marella, Hemnishil K.
AU - Aksionav, Pavel
AU - Iqbal, Umair
AU - Tombazzi, Claudio
AU - Howden, Colin W.
N1 - Publisher Copyright:
© 2020 Informa UK Limited, trading as Taylor & Francis Group.
PY - 2020/12
Y1 - 2020/12
N2 - Background: Studies evaluating the role of tranexamic acid in acute upper GI bleeding (UGIB) have reported conflicting results. In this systematic review, we have evaluated the efficacy and safety of tranexamic acid in UGIB. Methods: We searched several databases from inception to June 6, 2020 to identify randomised controlled trials (RCTs) that compared tranexamic acid and placebo in UGIB. Our outcomes of interest were mortality, rebleeding, all thromboembolic events, venous thromboembolic events, need for transfusion, endoscopic intervention and surgery. Pooled risk ratios (RR) with 95% confidence intervals (CI) were calculated using fixed effect model. We used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework to assess the certainty of evidence. Results: We included 12 RCTs comprising 14,100 patients. We found no significant difference in mortality, pooled RR (95% CI) 0.87 (0.74–1.01), rebleeding, pooled RR (95% CI) 0.90 (0.79–1.02), need for surgery, pooled RR (95% CI) 0.86 (0.73–1.02), need for transfusion, pooled RR (95% CI) 1.00 (0.99–1.01) or thromboembolic events, RR (95% CI) 1.16 (0.87–1.56) between treatments. We found an increased risk of venous thromboembolic events with tranexamic acid, pooled RR (95% CI) 1.94 (1.23–3.05). Certainty of evidence based on the GRADE framework for the different outcomes ranged from low to very low. Conclusions: Tranexamic acid does not improve outcomes in UGIB and may increase the risk of venous thromboembolic events.
AB - Background: Studies evaluating the role of tranexamic acid in acute upper GI bleeding (UGIB) have reported conflicting results. In this systematic review, we have evaluated the efficacy and safety of tranexamic acid in UGIB. Methods: We searched several databases from inception to June 6, 2020 to identify randomised controlled trials (RCTs) that compared tranexamic acid and placebo in UGIB. Our outcomes of interest were mortality, rebleeding, all thromboembolic events, venous thromboembolic events, need for transfusion, endoscopic intervention and surgery. Pooled risk ratios (RR) with 95% confidence intervals (CI) were calculated using fixed effect model. We used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework to assess the certainty of evidence. Results: We included 12 RCTs comprising 14,100 patients. We found no significant difference in mortality, pooled RR (95% CI) 0.87 (0.74–1.01), rebleeding, pooled RR (95% CI) 0.90 (0.79–1.02), need for surgery, pooled RR (95% CI) 0.86 (0.73–1.02), need for transfusion, pooled RR (95% CI) 1.00 (0.99–1.01) or thromboembolic events, RR (95% CI) 1.16 (0.87–1.56) between treatments. We found an increased risk of venous thromboembolic events with tranexamic acid, pooled RR (95% CI) 1.94 (1.23–3.05). Certainty of evidence based on the GRADE framework for the different outcomes ranged from low to very low. Conclusions: Tranexamic acid does not improve outcomes in UGIB and may increase the risk of venous thromboembolic events.
KW - Tranexamic acid
KW - meta-analysis
KW - randomised controlled trials
KW - upper gastrointestinal bleeding
UR - http://www.scopus.com/inward/record.url?scp=85094675135&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85094675135&partnerID=8YFLogxK
U2 - 10.1080/00365521.2020.1839963
DO - 10.1080/00365521.2020.1839963
M3 - Review article
C2 - 33112175
AN - SCOPUS:85094675135
SN - 0036-5521
VL - 55
SP - 1390
EP - 1397
JO - Scandinavian Journal of Gastroenterology
JF - Scandinavian Journal of Gastroenterology
IS - 12
ER -