June 27, 2020
Background: Acute gastrointestinal bleeding (GIB) is a common diagnosis dealt with by emergency clinicians. Definitive therapy for acute GIB often includes endoscopy or surgery. However, there is a myriad of pharmaceutical options (i.e. PPI, Somatostatin Analogues, Antibiotics, etc.) as well as blood products that may be instituted as part of the acute resuscitation of these patients. The role of tranexamic acid (TXA) in resuscitation of this condition is unknown.
TXA has become one of the darling medications of emergency medicine, with numerous indications, minimal side effect profile and low cost. TXA works by inhibiting blood clot breakdown (i.e. fibrinolysis). TXA has been shown to decrease death from bleeding in other conditions (Trauma, Postpartum hemorrhage) but there is limited evidence for its use in GIB. A systematic review and meta-analysis of seven randomized trials with just over 1600 patients  showed a reduction in all-cause mortality. However, the individual trials were small and prone to a myriad of biases making these conclusions hypothesis generating at best....Read More