TXA in GI Bleeds


Tranexamic Acid (TXA) has gained a significant amount of attention over the last few years as multiple studies have shown it’s utility in decreasing haemorrhage and associated mortality. It has become part of major trauma guidelines, post part haemorrhage protocols and many have adopted it to the management of traumatic brain injury. The findings have been very similar across a spectrum of haemorrhage disease processes and from this further interest in expanding TXA’s application to pretty much anything that bleeds. Time from onset of the bleeding has been shown to be important, with it’s effect decreasing from time of onset to its administration.

Gastro-intestinal bleeding is a significant cause of morbidity and mortality. Previous meta-analyses have shown favourable outcomes for TXA in GI bleeds and many have already adopted TXA into this area of practice, although guidance from NICE does not yet recommend it.

HALT-IT is a multi centre, international, randomised double blind controlled trial of near 12,000 patients that has just been published in the Lancet. The study was a huge piece of work and looks to definitively answer the question of whether we should be giving TXA to patients with life threatening GI bleeds. In this podcast we run through the ins and outs of the paper ad are lucky enough to speak to the lead author Ian Roberts about the findings, some of the intricacies of the trial and what the results mean for practice.

Enjoy!

SimonRob & James

References

Effects of a high-dose 24-h infusion of tranexamic acid on death and thromboembolic events in patients with acute gastrointestinal bleeding (HALT-IT): an international randomised, double-blind, placebo-controlled trial

Effects of tranexamic acid on death, disability, vascular occlusive events and other morbidities in patients with acute traumatic brain injury (CRASH-3): a randomised, placebo-controlled trial. The CRASH-3 trial collaborators. Lancet. 2019

The CRASH-2 trial: a randomised controlled trial and economic evaluation of the effects of tranexamic acid on death, vascular occlusive events and transfusion requirement in bleeding trauma patients. Roberts I. Health Technol Assess. 2013

CRASH-2; The Bottom Line

Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial. WOMAN Trial Collaborators.Lancet 2017

Acute upper gastrointestinal bleeding in over 16s: management. NICE Clinical guideline [CG141] Published date: Last updated:

The Predictive Value of Pre-Endoscopic Risk Scores to Predict Adverse Outcomes in Emergency Department Patients with Upper Gastrointestinal Bleeding – A Systematic Review. Ramaekers R. Acad Emerg Med. 2016

Tranexamic acid for upper gastrointestinal bleeding. Cochrane Systematic Review. 2014

Upper GI bleed; what’s the risk? The Resus Room

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