Tranexamic Acid in Gastrointestinal Bleeding: A Systematic Review and Meta-Analysis.
Review published in Critical care medicine (2022)
Abstract
OBJECTIVES: Tranexamic acid is proposed as a treatment for gastrointestinal bleeding. The Haemorrhage Alleviation with Tranexamic Acid-Intestinal System trial evaluated extended-use (24 hr) high-dose tranexamic acid, prompting a reappraisal for tranexamic acid in gastrointestinal bleeding. DATA SOURCES: We conducted a systematic review and meta-analysis of randomized controlled trials comparing tranexamic acid with usual care or placebo in adults with gastrointestinal bleeding. We searched MEDLINE, EMBASE, and CENTRAL (inception to September 2019). DATA SELECTION: Two reviewers independently screened citations, extracted data, and assessed the risk of bias using the Cochrane risk of bias tool in duplicate. The main outcomes were mortality, bleeding, and adverse events. DATA EXTRACTION: Studies were analyzed as high-dose IV tranexamic acid versus all other dosing strategies for tranexamic acid using fixed-effects models. We assessed certainty of evidence using the Grading of Recommendations Assessment, Development, and Evaluation approach. DATA SYNTHESIS: Five randomized controlled trials evaluated extended-use high-dose IV tranexamic acid, seven evaluating low-dose IV or enteral tranexamic acid. Extended-use high-dose IV tranexamic acid did not reduce mortality (relative risk, 0.98%; 95% CI, 0.88-1.09; I2 = 63%; high certainty) or bleeding (relative risk, 0.92; 95% CI, 0.82-1.04; p = 0.17 and absolute risk differences, -0.7%; 95% CI, -1.5 to 0.3; high certainty) but resulted in a small increase in deep venous thrombosis (relative risk, 2.01; 95% CI, 1.08-3.72; I2 = 0%), pulmonary embolism (relative risk, 1.78; 95% CI, 1.06-3.0; I2 = 0%), and seizure (relative risk, 1.73; 95% CI, 1.03-2.93) with high certainty. Low-dose IV/enteral tranexamic acid did not reduce mortality (relative risk, 0.62; 95% CI, 0.36-1.09; I2 = 0%) but did reduce risk of rebleeding (relative risk, 0.5; 95% CI, 0.33-0.75; I2 = 9%) and need for surgery (relative risk, 0.58; 95% CI, 0.38-0.88; I2 = 11%), with moderate certainty. CONCLUSIONS: Extended-use high-dose IV tranexamic acid does not improve mortality or bleeding outcomes and increases adverse events. Low-dose/enteral tranexamic acid may be effective in reducing hemorrhage; more evidence is required to demonstrate its safety.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Resumen
Tranexamic acid is proposed as a treatment for gastrointestinal bleeding. The Haemorrhage Alleviation with Tranexamic Acid-Intestinal System trial evaluated extended-use (24 hr) high-dose tranexamic acid, prompting a reappraisal for tranexamic acid in gastrointestinal bleeding.
Por qué esto importa para la hirudoterapia
Esta revisión sistemática y metaanálisis de ensayos controlados aleatorizados evaluó el ácido tranexámico para la hemorragia gastrointestinal y encontró que el ácido tranexámico IV en dosis altas de uso prolongado no redujo la mortalidad (RR 0.98) ni la hemorragia (RR 0.92), pero aumentó la trombosis venosa profunda, el embolismo pulmonar y las convulsiones (certeza alta), mientras que la dosificación IV/enteral en dosis bajas redujo el resangrado (RR 0.5) y la necesidad de cirugía (RR 0.58) con certeza moderada, aunque sin un beneficio en la mortalidad. Para la ASH, es un punto de referencia aleccionador y metodológicamente riguroso en el extremo opuesto del espectro hemostático de los agentes anticoagulantes derivados de sanguijuelas, que demuestra que llevar la coagulación demasiado lejos (aquí, mediante un antifibrinolítico) conlleva un daño trombótico real, reflejando el equilibrio entre hemorragia y coagulación que define el descubrimiento de fármacos anticoagulantes. El estudio se refiere al ácido tranexámico, no a las sanguijuelas ni a la hirudoterapia, e incluso como evidencia de alta certeza, solo se refiere a ese fármaco, no a las intervenciones basadas en sanguijuelas.
Citación
Tranexamic Acid in Gastrointestinal Bleeding: A Systematic Review and Meta-Analysis.
Dionne JC et al. · Critical care medicine, 2022
Contexto clínico relacionado
Explore cómo esta investigación se conecta con la práctica clínica
Añadido a la biblioteca ASH: May 28, 2026 · Última actualización del sitio: June 18, 2026