P2401 - Balancing Benefits and Risks: Evaluating Tranexamic Acid for Management of Acute GI Bleeding - A Systematic Review and Meta-Analysis

Yash R. Shah, MD¹, Ernesto Calderon-Martinez, MD², Fides Myles C. Caliwag, MD, MBA³, Nathnael Abera Woldehana, MD⁴, Gabriela Briceno Silva, MD⁵, Rodrigo Sebastian Maldonado, MD⁶, Nabin Khadka, MD⁷, Rubeliz Bolivar-Barrios, MD⁸, Charmy Parikh, MD⁹, Mihir P. Shah, MD¹⁰, Raj H. Patel, MD¹¹, Rashmi Advani, MD^12
1Trinity Health Oakland / Wayne State University School of Medicine, Pontiac, MI; ²University of Texas at Houston, Houston, TX; ³Ateneo School of Medicine and Public Health, Pasig, National Capital Region, Philippines; ⁴Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; ⁵Universidad de Oriente, Cumana, Sucre, Venezuela; ⁶Universidad Nacional de Cordoba, Cordoba, Cordoba, Argentina; ⁷Virgen Milagrosa University Foundation, San Carlos, Pangasinan, Philippines; ⁸Universidad de Oriente, Puerto La Cruz, Anzoategui, Venezuela; ⁹Mercy Catholic Medical Center, Darby, PA; ¹⁰John H. Stroger, Jr. Hospital of Cook County, Cook County, IL; ¹¹St. Mary Medical Center, Bensalem, PA; ¹²Mount Sinai South Nassau, Icahn School of Medicine at Mount Sinai, Oceanside, NY

Introduction: Gastrointestinal (GI) bleeding is a prevalent medical emergency, causing substantial hospitalizations globally. Mortality remains high (2.4-11%) despite therapeutic advancements. Tranexamic acid (TXA), an antifibrinolytic medication, has been proposed to reduce bleeding by inhibiting clot breakdown. However, the HALT-IT trial raised questions about efficacy and safety, showing no mortality reduction and potential thromboembolic complications. This meta-analysis evaluates TXA's effectiveness and safety in treating acute GI bleeding.

Methods: This systematic review and meta-analysis adhered to PRISMA 2020 guidelines. A comprehensive literature search using relevant MeSH terms and keywords for TXA and GI bleeding was conducted across PubMed, ICTRP,ClinicalTrials.gov, Web of Science, Google Scholar, CINAHL, Cochrane Library, EMBASE, Scopus, LILACS, and CNKI databases (search date: March 29, 2024). We focused on patients with acute GI bleeding receiving TXA compared to placebo or standard treatment. Primary outcomes measured included mortality, blood transfusion requirements, surgical intervention need,and thromboembolic events. Randomized controlled trials (RCTs) and observational studies in English or Spanish were included.

Results: The search yielded 6,810 articles. After title and abstract screening, 77 articles underwent full-text review, and 17 studies (totaling 2,059,147 participants) met the inclusion criteria. The meta-analysis revealed no significant increase in blood transfusion needs (RR 1.15, 95% CI: 0.67-1.98) with TXA. There was a trend towards increased thrombotic events in the TXA group (RR 1.09, 95% CI: 0.49-2.43), however, it did not reach statistical significance. TXA use reduced the need for surgical intervention (RR 0.86, 95% CI: 0.77-0.95) but showed no significant impact on mortality (RR 0.9392, 95% CI:0.6981-1.2634), endoscopic interventions (RR0.95, 95% CI:0.76,1.19), and rebleeding rates (RR: 0.81, 95% CI: 0.64-1.02). (Figure 1).

Discussion: TXA may decrease rebleeding and transfusion needs in acute GI bleeding, but its use carries potential risks like thromboembolic events. Further large-scale, well-designed RCTs are crucial to confirm TXA's efficacy and safety in this context. Conflicting results necessitate cautious interpretation and individualized patient management when considering TXA for GI bleeding.



Disclosures:


Yash R. Shah, MD¹, Ernesto Calderon-Martinez, MD², Fides Myles C. Caliwag, MD, MBA³, Nathnael Abera Woldehana, MD⁴, Gabriela Briceno Silva, MD⁵, Rodrigo Sebastian Maldonado, MD⁶, Nabin Khadka, MD⁷, Rubeliz Bolivar-Barrios, MD⁸, Charmy Parikh, MD⁹, Mihir P. Shah, MD¹⁰, Raj H. Patel, MD¹¹, Rashmi Advani, MD¹². P2401 - Balancing Benefits and Risks: Evaluating Tranexamic Acid for Management of Acute GI Bleeding - A Systematic Review and Meta-Analysis, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.