Tranexamic acid may help with upper GI bleeding after esophageal variceal ligation

Tranexamic acid significantly helped with upper GI bleeding in patients with advanced liver cirrhosis who underwent esophageal variceal ligation, a study found.

To evaluate the efficacy and safety of tranexamic acid in treatment of acute upper GI bleeding in patients with cirrhosis, researchers in India randomized 600 patients with cirrhosis (Child-Turcotte-Pugh class B or C) presenting with upper GI bleeding to either tranexamic acid (n=300) or placebo (n=300). Patients in the tranexamic acid group received a loading dose of 1 g of tranexamic acid added to 100 mL of normal saline infused slowly over 10 minutes, followed by a maintenance dose of 3 g of tranexamic acid added to 1,000 mL of normal saline infused over 24 hours. Infusion was the same for the placebo group.

The primary outcome measure was the proportion of patients with five-day treatment failure, defined as absence of control of bleeding or rebleeding within five days. Secondary outcome measures included failure to prevent rebleeding after five days; need for salvage therapy; use of blood products; duration of ICU and hospital stay; adverse events including thromboembolic events and seizures; and overall mortality and bleeding-related mortality. Results were published March 5 by Hepatology.

Failure to control bleeding by day 5 was seen in 19 (6.3%) patients in the tranexamic acid group and 40 (13.3%) patients in the placebo group (P=0.006). Among patients undergoing the esophageal variceal ligation (EVL) for the first time, the EVL site was the source of failure to control bleeding by day 5 in 11 of 222 (4.9%) patients in the tranexamic acid group and 27 of 225 (12.0%) in the placebo group (P=0.005). Mortality at five days and six weeks was similar in the tranexamic acid and placebo groups.

The study authors observed that the relatively high rate of EVL site bleeding in the control group could be attributed to the severity of illness and advanced stage of cirrhosis in the studied patients. They concluded that "tranexamic acid significantly reduced the failure to control bleeding by day 5 and failure to prevent rebleeding after day 5 till 6 weeks."