Tranexamic acid in upper gastrointestinal bleed in patients with cirrhosis: A randomized controlled trial

Hepatology. 2024 Aug 1;80(2):376-388. doi: 10.1097/HEP.0000000000000817. Epub 2024 Mar 5.

Abstract

Background and aims: Patients with Child-Turcotte-Pugh class B and C cirrhosis with upper gastrointestinal bleeding (UGIB) have systemic as well as localized (in the mucosa of the esophagus and stomach) fibrinolysis. The aim of this study was to evaluate the efficacy and safety of tranexamic acid in the treatment of acute UGIB in patients with cirrhosis.

Approach and results: A total of 600 patients with advanced liver cirrhosis (Child-Turcotte-Pugh class B or C) presenting with UGIB were randomly allocated to either the tranexamic acid (n=300) or the placebo group (n=300). The primary outcome measure was the proportion of patients developing 5-day treatment failure. Failure to control bleeding by day 5 was seen in 19/300 (6.3%) patients in the tranexamic acid group and 40/300 (13.3%) patients in the placebo group ( p =0.006). Esophageal endoscopic variceal ligation (EVL) site as a source of failure to control bleeding by day 5 among patients undergoing first-time esophageal EVL (excluding patients with a previous post-EVL ulcer as a source of bleed) was seen in 11/222 (4.9%) patients in the tranexamic acid group and 27/225 (1212.0%) patients in the placebo group ( p =0.005). However, 5-day and 6-week mortality was similar in the tranexamic acid and placebo groups.

Conclusions: Tranexamic acid significantly reduces the failure to control bleeding by day 5 and failure to prevent rebleeding after day 5 to 6 weeks in patients with advanced liver cirrhosis (Child-Turcotte-Pugh class B or C) presenting with UGIB, by preventing bleeding from the EVL site.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Aged
  • Antifibrinolytic Agents* / administration & dosage
  • Antifibrinolytic Agents* / therapeutic use
  • Double-Blind Method
  • Esophageal and Gastric Varices / complications
  • Esophageal and Gastric Varices / drug therapy
  • Esophageal and Gastric Varices / etiology
  • Female
  • Gastrointestinal Hemorrhage* / drug therapy
  • Gastrointestinal Hemorrhage* / etiology
  • Gastrointestinal Hemorrhage* / prevention & control
  • Humans
  • Liver Cirrhosis* / complications
  • Male
  • Middle Aged
  • Tranexamic Acid* / administration & dosage
  • Tranexamic Acid* / therapeutic use
  • Treatment Outcome

Substances

  • Tranexamic Acid
  • Antifibrinolytic Agents