Outcomes of Tranexamic Acid Treatment in Patients with Upper Gastrointestinal Bleeding: An Overview of Reviews.

Abstract

Background: Upper gastrointestinal bleeding (UGIB) is a life-threatening emergency requiring prompt management. Standard treatments include endoscopic intervention, blood transfusions, and pharmacological therapies such as proton pump inhibitors (PPIs) and antifibrinolytics like tranexamic acid (TXA). However, the efficacy of TXA in UGIB remains controversial due to mixed findings. This systematic review analyzed six systematic reviews covering 34,351 patients. The objective is to assess TXA's effectiveness in reducing mortality, rebleeding, and thromboembolic events, as well as secondary outcomes such as transfusion requirements, surgery, hospital stay, and adverse events.

Methods: Studies on non-GI bleeding, pediatric populations, and non-peer-reviewed articles were excluded. A comprehensive search across PubMed, Cochrane Library, ScienceDirect, and DOAJ (2014-2024) identified 157 records, with six systematic reviews/meta-analyses (34,351 participants) meeting inclusion criteria. Risk of bias was assessed using AMSTAR 2, with two studies rated as high confidence and four as moderate confidence.

Results: Current high-quality evidence does not support routine TXA use for mortality reduction in UGIB. Safety remains uncertain, particularly with prolonged high-dose administration.

Conclusion: These findings are consistent with the 2022 Indonesian national consensus, which advises against routine TXA use in UGIB. Future research should focus on optimized dosing strategies, timing of administration, and identification of clinically relevant subgroups to clarify its therapeutic role.