Upper GI bleed: tranexamic acid reduces mortality but not rebleeding or the need for surgery

Clinical bottom line (level 1a)

  1. Patients with upper GI bleeds who receive tranexamic acid compared with placebo are less likely to die (NNT = 27 at unknown) .
  2. There is no clear effect on rebleeding or mortality.
Henry and O'Connell: British Medical Journal 1989; 298: 1142-1146
Expires January 2003

The study

Systematic review of randomised controlled trials of
  • Patients: upper gastrointestinal haemorrhage
  • Intervention: tranexamic acid (either 3-6 g iv daily for 3 days, followed by 3-6 g po daily for 3 to 5 days; or 12 g daily orally for 2 days, followed by 4.5 g daily for 7 days) compared with placebo
  • Outcome: rebleeding, surgery, death


Articles found in ?English using MEDline and Index Medicus, 1967 to 1989 (search terms: aminocaproic acids, tranexamic acid, haemorrhage, gastrointestinal ) and and bibliographies of retrieved articles and reviews. Manufacturers and authors of trials were also contacted.

Selection criteria: not detailed
Appraisal criteria: not detailed
Articles excluded if: ?

6 studies found involving 1267 patients (mainly elderly)
Studies were found to be heterogenous for surgery.

The evidence

Outcome Time to outcome CER OR
(95% CI)		 NNT
(95% CI)
rebleeding unknown 134/637
(19.5%)		 0.80
(0.61 to 1.10) 		31
(NNT = 15 to infinity;
NNH = 65 to infinity)
operation unknown 109/563
(19.4%)		 0.72
(0.52 to 1.00) 		22
(12 to infinity)
death unknown 66/637
(%)		 0.60
(0.40 to 0.89) 		26
(17 to 97)

Comments

  1. 0.04% of patients on tranexamic acid develop thromboembolic events - most had superficial thrombophlebitis. One patient may have died from a fatal stroke.

Citation

  1. Henry DA, and O'Connell DL: Effects of fibrinolytic inhibitors on mortality from upper gastrointestinal haemorrhage. British Medical Journal 1989; 298: 1142-1146
Contributor: Chris Ball and Musab Hayatli, Unknown Month 1999
Reviewer:

Clinical Question.
    Patient upper GI bleed
    Intervention or Exposure tranexamic acid
    Outcome rebleeding, surgery, death