scholarly journals Is There a Role for Tranexamic Acid in Upper GI Bleeding? A Systematic Review and Meta-Analysis

2021 ◽  
Vol 2021 ◽  
pp. 1-12
Author(s):  
Eoghan Burke ◽  
Patricia Harkins ◽  
Ibrahim Ahmed
Keyword(s):  
Systematic Review ◽  
Tranexamic Acid ◽  
Risk Ratio ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Thromboembolic Events ◽  
Gi Bleeding ◽  
Upper Gi Bleeding ◽  
Upper Gi ◽  
The Mean

Introduction. Upper gastrointestinal (GI) bleeding is associated with increased morbidity and mortality. Tranexamic acid (TXA) is an antifibrinolytic agent which is licensed in the management of haemorrhage associated with trauma. It has been suggested that tranexamic acid may be able to play a role in upper GI bleeding. However, there is currently no recommendation to support this. Aim. The aim of this study was to synthesise available evidence of the effect of TXA on upper GI bleeding. Methods and Materials. A systematic review was conducted. PubMed, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL) were searched for relevant studies. A random effects meta-analysis was performed to determine the risk ratio of primary and secondary outcomes pertaining to the use of TXA in upper GI bleeding. Results. A total of 8 studies were included in this systematic review. The total number of patients in all studies was 12994 including 4550 females (35%) and 8444 males (65%). The mean age of participants in 6 of the studies was 59.3; however the mean age for either intervention or placebo group was not reported in two of the studies. All studies reported on the effect of TXA on mortality, and the risk ratio was 0.95; however, with the 95% CI ranging from 0.80 to 1.13, this was not statistically significant. 6 of the studies reported on rebleeding rate, the risk ratio was 0.64, and with a 95% CI ranging from 0.47 to 0.86, this was statistically significant. 3 of the studies reported on the risk of adverse thromboembolic events, and the risk ratio was 0.93; however, the 95% CI extended from 0.62 to 1.39 and so was not statistically significant. 7 of the studies reported on the need for surgery, and the risk ratio was 0.59 and was statistically significant with a 95% CI ranging from 0.38 to 0.94. Conclusion. In conclusion, the use of TXA in upper GI bleeding appears to have a beneficial effect in terms of decreasing the risk of re-bleeding and decreasing the need for surgery. However, we could not find a statistically significant effect on need for blood transfusions, risk of thromboembolic events, or effect on mortality. Future randomised controlled trials may elucidate these outcomes.

scholarly journals 381 Is There A Role for Tranexamic Acid in Upper GI Bleeding? A Systematic Review and Meta-Analysis

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
E Burke ◽  
H Malik ◽  
F Awan ◽  
P Balfe
Keyword(s):  
Systematic Review ◽  
Tranexamic Acid ◽  
Risk Ratio ◽  
Meta Analysis ◽  
Cochrane Central Register ◽  
Gi Bleeding ◽  
Upper Gi Bleeding ◽  
Upper Gi ◽  
Number Of Patients ◽  
Randomised Controlled

Abstract Introduction Upper Gastrointestinal bleeding is associated with increased morbidity and mortality. It has been suggested that tranexamic acid (TXA) may be useful in arresting bleeding. Aim: To synthesise available evidence of the effect of TXA on upper GI bleeding. Method A systematic review was conducted. PubMed, EMBASE and Cochrane central register of controlled trials were searched for relevant studies. A random effects meta-analysis was performed to determine the risk ratio of primary and secondary outcomes. Results 8 studies were included in the review. Total number of patients included was 12994 including 4550 females (35%). The effect of TXA on mortality: risk ratio was 0.95 which favoured TXA however the 95% CI ranged from 0.80 to 1.13 and was not statistically significant. The re-bleeding rate risk ratio was 0.64, which favoured the TXA group and with a 95% CI ranging from 0.47 to 0.86 this was statistically significant. The risk of adverse thromboembolic events: risk ratio was 0.93 favoured the TXA group however the 95% CI extended from 0.62 to 1.39 and so was not statistically significant. Conclusions We cannot recommend the routine use of TXA in the setting of acute upper GI bleeding outside its use in randomised controlled clinical trials.

scholarly journals Erythromycin before Endoscopy in Upper GI Bleeding: A Meta-Analysis of Randomized Controlled Trials

2012 ◽  
Vol 107 ◽  
pp. S747-S748
Author(s):  
Shoba Theivanayagam ◽  
Roxanne Lim ◽  
William Cobell ◽  
Jayashree Gowda ◽  
Michelle Matteson ◽  
...  
Keyword(s):  
Randomized Controlled Trials ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Gi Bleeding ◽  
Upper Gi Bleeding ◽  
Upper Gi ◽  
Randomized Controlled

Tu1103 HEMOSPRAY MONOTHERAPY FOR NON-VARICEAL UPPER GI BLEEDING: A META-ANALYSIS

2019 ◽  
Vol 89 (6) ◽  
pp. AB558 ◽  
Author(s):  
Courtney J. Cockerell ◽  
Nasim Parsa ◽  
Michelle L. Matteson-Kome ◽  
Sami Samiullah ◽  
Douglas L. Nguyen ◽  
...  
Keyword(s):  
Meta Analysis ◽  
Gi Bleeding ◽  
Upper Gi Bleeding ◽  
Upper Gi

scholarly journals Effectiveness of orthodontic temporary anchorage devices in canine retraction and anchorage preservation during the two-step technique: a systematic review and meta-analysis

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Haonan Tian ◽  
Congman Xie ◽  
Min Lin ◽  
Hongmei Yang ◽  
Aishu Ren
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Canine Retraction ◽  
Temporary Anchorage Devices ◽  
The Mean ◽  
Mean Differences ◽  
Implant Anchorage

Abstract Background Temporary anchorage devices have been used for decades in orthodontic practice for many applications. The aim of this systematic review was to assess the effectiveness of orthodontic temporary anchorage devices in canine retraction during the two-step technique. Methods A search was systematically performed for articles published prior to June 30, 2019 in five electronic databases (PubMed, Embase, Cochrane Central Register of Controlled Trials, Web of Science, Scopus). The risk of bias was assessed using the Cochrane risk of bias tool for randomized controlled trials (RCTs) and the risk of bias in nonrandomized studies of interventions (ROBINS-I) tool for controlled clinical trials (CCTs). The Grading of Recommendation, Assessment, Development and Evaluation (GRADE) approach was used for the quality assessment. Data concerning the mean difference in mesial molar movement and extent of canine retraction were extracted for statistical analysis. The mean differences and 95% confidence intervals were analyzed for continuous data. A meta-analysis with a random-effects model for comparable outcomes was carried out. Results Three RCTs and five CCTs were finally included. Meta-analysis showed a significant increase not only in anchorage preservation in the implant anchorage group in both the maxilla (1.56 mm, 95% CI: 1.14 to 1.98, P < 0.00001) and the mandible (1.62 mm, 95% CI: 1.24 to 2.01, P < 0.00001) but also in canine retraction in the implant anchorage group in both the maxilla (0.43 mm, 95% CI: 0.16 to 0.69, P = 0.001) and the mandible (0.26 mm, 95% CI: 0.02 to 0.49, P = 0.03). Conclusions There is very low-quality evidence showing that implant anchorage is more efficient than conventional anchorage during canine retraction. Additional high-quality studies are needed.

scholarly journals Facteurs Épidémiologiques et Pronostiques Associés Aux Étiologies Des Hémorragies Digestives Hautes au CHU Campus de Lomé

2021 ◽  
Vol 17 (34) ◽  
pp. 44
Author(s):  
Aklesso Bagny ◽  
Lidawu Roland-Moise Kogoe ◽  
Laconi Yeba Kaaga ◽  
Late Mawuli Lawson-Ananissoh ◽  
Debehoma Redah ◽  
...  
Keyword(s):  
Teaching Hospital ◽  
Cross Sectional Study ◽  
Mean Value ◽  
Peptic Ulcers ◽  
Gi Bleeding ◽  
Cross Sectional ◽  
Hémorragies Digestives ◽  
Upper Gi Bleeding ◽  
Upper Gi ◽  
The Mean

Objectif : Décrire les aspects épidémiologique, clinique et pronostique associés aux étiologies des hémorragies digestives hautes au CHU Campus de Lomé Patients et méthode: Etude transversale à collecte rétrospective, à visée descriptive et analytique menée du 1er Janvier 2014 au 31 Décembre 2019. Le seuil de significativité était retenu pour p<0,05. Résultats: Deux cent cinquante et un patients avaient été inclus. L’hémorragie était d’origine hypertensive portale chez 69 patients (27,71%) ; ulcéreuse gastro-duodénale chez 100 patients (39,84%). Chez 25 patients (9,96%), la fibroscopie oesogastroduodénale était normale. Une rupture de varices oesophagiennes était retrouvée chez 98,55% des patients présentant une hypertension portale. Les ulcères gastroduodénaux représentaient 54,94% des hémorragies digestives hautes d’origine non hypertensive portale. La valeur moyenne du score de Rockall était de 4(±1) chez les patients présentant une hémorragie d’origine hypertensive et de 3(±1) chez les patients avec hémorragie non hypertensive portale (p<0,001). La valeur moyenne du score de Glasgow-Blatchford était de 10(±3) chez les patients présentant une hémorragie d’origine hypertensive et 9(±3) chez les patients avec hémorragie digestive haute d’origine non hypertensive (p<0,001). La récidive hémorragique et le décès étaient survenus chez les patients présentant un saignement d’origine hypertensive portale dans respectivement 54,84% (p<0,001) et 71,42% (p<0,001). Conclusion: Les lésions inflammatoires aiguës et chroniques représentent la première étiologie des hémorragies digestives hautes dans le service d’Hépato-gastroentérologie du CHU Campus. Ces hémorragies sont associées à la prise de médicaments gastrotoxiques et à un moindre risque de récidive hémorragique et de décès. Objective: To describe epidemiological et prognostic outcomes associated with etiologies upper gastrointestinal bleeding in Campus Teaching Hospital of Lome Patients and method: Cross-sectional study with retrospective collection, descriptive and analytical aim carried out from January 1, 2014 to December 31, 2019. Results: Two hundred and one patients were included. The hemorrhage was of portal hypertensive origin in 69 patients (27.71%); peptic ulcer in 100 patients (39.84%). In 25 patients (9.96%), the oesogastroduodenal fibroscopy was normal. Ruptured esophageal varices were found in 98.55% of patients with portal hypertension. Peptic ulcers accounted for 54.94% of upper GI bleeding of non-portal hypertensive origin. The mean value of the Rockall score was 4(±1) in patients with hemorrhage of hypertensive origin and 3(±1) in patients with non-portal hypertensive hemorrhage (p<0.001). The mean Glasgow-Blatchford score was 10(±3) in patients with hemorrhage of hypertensive origin and 9(±3) in patients with upper GI hemorrhage of nonhypertensive origin (p<0.001). Hemorrhagic recurrence and death occurred in patients with bleeding of hypertensive origin in 54.84% (p<0.001) and 71.42% (p<0.001) respectively. Conclusion: Acute and chronic inflammatory lesions represent the first etiology of upper GI bleeding in the Gastroenterology Department of the Campus Teaching Hospital of Lome. These hemorrhages are associated with the use of gastrotoxic drugs and with a lower risk of recurrence of hemorrhage and death.

Optimal timing of vitamin K antagonist resumption after upper gastrointestinal bleeding

2017 ◽  
Vol 117 (03) ◽  
pp. 491-499 ◽  
Author(s):  
Niklas Wallvik ◽  
Joakim Eriksson ◽  
Jonas Höijer ◽  
Matteo Bottai ◽  
Margareta Holmström ◽  
...  
Keyword(s):  
Vitamin K ◽  
Vitamin K Antagonists ◽  
Bleeding Event ◽  
Optimal Timing ◽  
Thromboembolic Events ◽  
Gi Bleeding ◽  
Upper Gi Bleeding ◽  
Upper Gi ◽  
Increased Risk ◽  
Upper Gastrointestinal

SummaryThe optimal timing of vitamin K antagonists (VKAs) resumption after an upper gastrointestinal (GI) bleeding, in patients with continued indication for oral anticoagulation, is uncertain. We included consecutive cases of VKA-associated upper GI bleeding from three hospitals retrospectively. Data on the bleeding location, timing of VKA resumption, recurrent GI bleeding and thromboembolic events were collected. A model was constructed to evaluate the ‘total risk’, based on the sum of the cumulative rates of recurrent GI bleeding and thromboembolic events, depending on the timing of VKA resumption. A total of 121 (58 %) of 207 patients with VKA-associated upper GI bleeding were restarted on anticoagulation after a median (interquartile range) of one (0.2–3.4) week after the index bleeding. Restarting VKAs was associated with a reduced risk of thromboembolism (HR 0.19; 95 % CI, 0.07–0.55) and death (HR 0.61; 95 % CI, 0.39–0.94), but with an increased risk of recurrent GI bleeding (HR 2.5; 95 % CI, 1.4–4.5). The composite risk obtained from the combined statistical model of recurrent GI bleeding, and thromboembolism decreased if VKAs were resumed after three weeks and reached a nadir at six weeks after the index GI bleeding. On this background we will discuss how the disutility of the outcomes may influence the decision regarding timing of resumption. In conclusion, the optimal timing of VKA resumption after VKA-associated upper GI bleeding appears to be between 3–6 weeks after the index bleeding event but has to take into account the degree of thromboembolic risk, patient values and preferences.

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