Tranexamic Acid for Upper Gastrointestinal Bleeding

Early Administration of Intravenous Tranexamic Acid for Upper Gastrointestinal Bleeding Prior to Endoscopy

This study is to see whether the early intravenous administration of tranexamic acid improves the outcome of acute upper gastrointestinal bleeding.

Previous studies reported that IV/Oral administration of tranexamic acid improves the outcome upper gastrointestinal bleeding. However, the drug is scarcely used nowadays as those studies are outdated in present clinical field where early endoscopic treatment and PPI administration are considered norm. Although a recent meta-analysis done by Cochrane review group concluded that it improves patient survival, other review articles including "Gut" suggested that a well-designed clinical study is needed for re-evaluation of the efficacy and safety of the drug in current clinical situation. We hypothesized that early administration of the drug will significantly decrease the proportion of patient requiring early endoscopic treatment.

Inclusion Criteria:

1. Chief complaint of hematemesis, melena or hematochezia
2. and objective signs of upper gastrointestinal bleeding

Exclusion Criteria:

1. Pregnant woman, age less than 18

2. Patients whose use of the study drug is contraindicated

   • Increased thromboembolic risk

     • History of thromboembolic disease
     • Alleged inherited thrombophilic disorders
     • Malignancy (except those cured and has not recurred more than two years)
     • Nephrotic syndrome
     • Estrogen use
     • Pregnancy
     • HIT, APA

   • High-risk for cardioembolism

     • Underlying structural heart disease where anticoagulation is indicated
     • Underlying cardiac rhythm disorder where anticoagulation is indicated (e.g. atrial fibrillation/flutter)

   • Possibilities of ongoing DIC

     • Signs and symptoms suggestive of clinically significant infectious disease (e.g. body temperature > 38 degree)
     • Any malignancy except those cured and has not recurred more than two years

   • Patients with history or presence of subarachnoid hemorrhage

   • Acquired color vision impairment, visual loss and retinal venous and arterial occlusions

   • Past history of seizure or organic brain lesion that predispose to seizure disorder

3. Previous history of variceal bleeding

4. Cases where informed consent is unobtainable