Effects of fibrinolytic inhibitors on mortality from upper gastrointestinal haemorrhage.
OBJECTIVE
To see whether fibrinolytic inhibitors are of value when given to patients with upper gastrointestinal haemorrhage.


METHODS
Meta-analysis of six randomised double blind placebo controlled trials. Two methods used for obtaining an overall estimate of effect, including a random effects model incorporating any heterogeneity of outcome in the estimate of the overall treatment effect.


METHODS
Inpatient care in hospitals in the United Kingdom, Sweden, and Australia.


METHODS
1267 Patients admitted to hospital with primary diagnosis of acute upper gastrointestinal haemorrhage. Five of the six trials included a high proportion of elderly patients. Most patients were bleeding from peptic ulcers in the stomach and duodenum (43-88%) or gastric erosions (4-23%). A variable proportion had a degree of clinical shock at entry.


METHODS
Tranexamic acid 3-6 g/day given intravenously for two or three days followed by 3-6 g/day by mouth for a further three to five days (four trials) or 4.5-12 g/day by mouth for two to seven days (two trials).


METHODS
Frequency of recurrent haemorrhage, need for surgery, and death.


RESULTS
Treatment with tranexamic acid was associated with a 20-30% reduction in the rate of rebleeding, a 30-40% reduction (95% confidence interval 10% to 60%) in mortality.


CONCLUSIONS
Treatment with tranexamic acid may be of value to patients considered to be at risk of dying after an upper gastrointestinal haemorrhage.
Henry
D A
DA
University of Newcastle, New South Wales, Australia.
O'Connell
D L
DL
D002986:Clinical Trials as Topic; D003509:Cyclohexanecarboxylic Acids / Q000627:therapeutic use*; D004311:Double-Blind Method; D006471:Gastrointestinal Hemorrhage / Q000188:drug therapy* / Q000401:mortality; D006801:Humans; D015201:Meta-Analysis as Topic; D008875:Middle Aged; D011897:Random Allocation; D014148:Tranexamic Acid / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*
D003509:Cyclohexanecarboxylic Acids; D014148:Tranexamic Acid