Tranexamic Acid [TXA] in Upper Gastrointestinal Bleeds – Systematic Review and Meta- analysis

Purpose Tranexamic acid [TXA] is an antifibrinolytic agent commonly used to reduce bleeding in various clinical settings. This systematic review and meta-analysis aimed to evaluate the effectiveness of TXA in the management of upper gastrointestinal [GI] bleeding. Methods We systematically searched Medline, Embase, PubMed, and the Cochrane CENTRAL database for randomized controlled trials [RCTs] that examined the use of TXA in patients with upper GI bleeding. Primary outcomes included mortality, rebleeding, adverse events, surgical intervention, and blood transfusion requirements. A meta-analysis was conducted using RevMan 5.4, applying a random-effects model to calculate relative risk [RR] with 95% confidence intervals [CI]. Results TXA use was associated with a significantly increased risk of adverse events [RR 1.44; 95% CI 0.39–5.33; P  = 0.001]. However, no statistically significant differences were observed for other clinical outcomes: mortality [RR 0.91; 95% CI 0.78–1.08; P  = 0.59], rebleeding [RR 0.75; 95% CI 0.60–0.95; P  = 0.16], need for surgery [RR 0.66; 95% CI 0.44–0.99; P  = 0.07], and transfusion requirement [RR 1.02; 95% CI 0.90–1.15; P  = 0.08]. Conclusion While TXA was linked to a higher risk of adverse events, its impact on key clinical outcomes in upper GI bleeding was not statistically significant. Until more robust evidence emerges, clinicians should continue to follow established treatment protocols when managing upper GI hemorrhage.