There is no evidence from randomised clinical trials to establish the beneficial or harmful effects of antifibrinolytic amino acids for upper gastrointestinal bleeding in patients with liver disease plus acquired coagulation disorders

Martí-Carvajal AJ, Solà I, Nicita G

Published Online:

January 20, 2010

Upper gastrointestinal bleeding is one of the most frequent causes of morbidity and mortality in the course of liver cirrhosis. Patients with liver disease frequently have haemostatic abnormalities, which include hyperfibrinolysis. Antifibrinolytic amino acids could be used to treat this gastrointestinal emergency. But, it is unknown whether it benefits or harms patients with liver disease plus acquired coagulation disorders and upper gastrointestinal bleeding. This updated review found no randomised clinical trials on the safety and efficacy of antifibrinolytic amino acids for upper gastrointestinal bleeding in patients with liver diseases.

Abstract (click to read)

Background:

Upper gastrointestinal bleeding is one of the most frequent causes of morbidity and mortality in the course of liver cirrhosis. Patients with liver disease frequently have haemostatic abnormalities, which include hyperfibrinolysis. There are several primary treatments for upper gastrointestinal bleeding in patients with liver diseases. Supplementary interventions are used as well and antifibrinolytic amino acids are among them.

Objectives:

To assess the beneficial and harmful effects of antifibrinolytic amino acids for upper gastrointestinal bleeding in patients with acute or chronic liver disease and leading to acquired coagulation disorders.

Search strategy:

We searched The Cochrane Hepato-Biliary Group Controlled Trials Register (December 2008), the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library (Issue 4, 2008), MEDLINE (1950 to December 2008), EMBASE (1980 to December 2008), Science Citation Index EXPANDED (1900 to December 2008), LILACS (1982 to January 2009), ClinicalTrials.gov (at www.clinicaltrials.gov) (accessed January 8, 2009), and the International Standard Randomised Controlled Trial Number Register (at http://controlled-trials.com/isrctn/search.asp) (accessed January 8, 2009). We also searched the Excelencia Clínica (January 8, 2009) and Sistema de Información Esencial en Terapéutica y Salud (January 9, 2009) clinical trials registers. We looked through the reference lists of the retrieved publications and review articles.

Selection criteria:

Randomised clinical trials irrespective of blinding, language, or publication status.

Data collection and analysis:

Data from randomised clinical trials were to be summarised by standard Cochrane Collaboration methodologies.

Main results:

We could not find any randomised clinical trials with antifibrinolytic amino acids for upper gastrointestinal bleeding in patients with acute or chronic liver disease plus acquired coagulation disorders.

Authors' conclusions:

No randomised clinical trials assessing the safety and efficacy of antifibrinolytic amino acids for upper gastrointestinal bleeding in patients with liver disease (acute or chronic) plus acquired coagulation disorders were identified. The benefits and harms of antifibrinolytic amino acids need to be tested in randomised clinical trials. Unless randomised clinical trials provide evidence of a treatment effect and the trade off between potential benefits and harms are established, policy-makers, clinicians, and academics should be cautious when administering antifibrinolytic amino acids for upper gastrointestinal bleeding in patients with acute or chronic liver diseases plus acquired disorders.

This record should be cited as:

Martí-Carvajal AJ, Solà I, Nicita G. Antifibrinolytic amino acids for acquired coagulation disorders in patients with liver disease. Cochrane Database of Systematic Reviews 2007, Issue 1. Art. No.: CD006007. DOI: 10.1002/14651858.CD006007.pub2

Assessed as up to date:

December 18, 2008

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Primary Review Group:

Hepato-Biliary Group

Health topics:

Gastroenterology > Oesophageal & gastric varices > Acute (& first time) bleeding gastric varices

Gastroenterology > Oesophageal & gastric varices > Acute (& first time) bleeding oesophageal varices

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

There is no evidence from randomised clinical trials to establish the beneficial or harmful effects of antifibrinolytic amino acids for upper gastrointestinal bleeding in patients with liver disease plus acquired coagulation disorders

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