Upper gastrointestinal bleeding is a common reason for emergency hospital admission. The prognosis is serious. Some patients may die due to uncontrolled bleeding. Previous evidence suggests that a number of effective treatments, including anti-ulcer drugs and endoscopic therapy, improve the prognosis of patients admitted with upper gastrointestinal bleeding. Tranexamic acid is an antifibrinolytic agent. The drug reduces the degradation of fibrin, which is the framework for the formation of a blood clot. Clinical trials have suggested that tranexamic acid reduces mortality in upper gastrointestinal bleeding.
The present review includes data from seven randomised trials. Two trials also assessed anti-ulcer drugs. Only one trial used additional endoscopic therapy since the remaining trials were performed before this intervention was introduced into clinical practice. The trials found a beneficial effect of tranexamic acid on mortality when compared with placebo but not on any of the remaining outcome measures assessed, including bleeding. No effect of tranexamic acid was identified in trials using anti-ulcer drugs or endoscopic therapy. Accordingly, additional evidence is needed before definite treatment recommendations can be made.