title: Topical tranexamic acid as a novel treatment for bleeding peptic ulcer: A randomised controlled trial.
abstract: BACKGROUND
  Peptic ulcers are among the most common causes of upper gastrointestinal (GI) bleeding in children. The standard care for GI bleeding is endoscopy for diagnostic and therapeutic purposes. We aimed to assess the effect of topical tranexamic acid (TXA) via endoscopic procedures in children with GI bleeding caused by bleeding ulcers.
  
  
  METHODS
  In this randomised controlled trial, 120 children were evaluated by diagnostic procedures for GI bleeding, of which 63 (30 girls, 33 boys) aged 1-month to 15 years were recruited. The patients were randomly divided into case and control groups. In the case group, TXA was administered directly under endoscopic therapy. In the control group, epinephrine (1/10,000) was submucosally injected to the four quadrants of ulcer margins as the routine endoscopic therapy. In both groups, the patients received supportive medical therapy with intravenous fluids and proton pump inhibitor drugs.
  
  
  RESULTS
  The mean ± standard deviation age of the children was 5 ± 2.03 years. Rebleeding occurred in 15 (11.4%) and 21 (9.8%) patients in the case and control groups, respectively (P = 0.50). The frequency of blood transfusion episodes (P = 0.06) and duration of hospital stay (P = 0.07) were not statistically different between the groups.
  
  
  CONCLUSIONS
  Using topical TXA via endoscopic procedures may be effective in cases of GI bleedings caused by active bleeding ulcers. In order to establish this therapeutic effect, a large number of clinical studies are needed.
authors.affiliation: Department of Pediatrics, Liver and Gastrointestinal Research Centre, Tabriz University of Medical Sciences, Tabriz, Iran.
authors.forename: Mandana
authors.initials: M
authors.lastname: Rafeey
authors.affiliation: Department of Pediatrics, Pediatric Health Research Centre, Tabriz University of Medical Sciences, Tabriz, Iran.
authors.forename: Maryam
authors.initials: M
authors.lastname: Shoaran
authors.affiliation: Department of Pediatrics, Tabriz University of Medical Sciences, Tabriz, Iran.
authors.forename: Robabeh
authors.initials: R
authors.lastname: Ghergherechi
mesh_terms: D000287:Administration, Topical; D000293:Adolescent; D000933:Antifibrinolytic Agents / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D016099:Endoscopy, Gastrointestinal; D004837:Epinephrine / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007223:Infant; D007279:Injections, Subcutaneous; D008297:Male; D010438:Peptic Ulcer Hemorrhage / Q000175:diagnosis / Q000188:drug therapy*; D014148:Tranexamic Acid / Q000008:administration & dosage*; D014662:Vasoconstrictor Agents / Q000008:administration & dosage
chemical_list: D000933:Antifibrinolytic Agents; D014662:Vasoconstrictor Agents; D014148:Tranexamic Acid; D004837:Epinephrine