S1434 Efficacy and Safety of Tranexamic Acid in Acute Gastrointestinal Bleeding: A Systematic Review and Meta-Analysis

Introduction: Acute gastrointestinal bleeding (AGIB) is a significant cause of emergency admissions associated with high morbidity and mortality. Tranexamic acid (TXA), an antifibrinolytic agent, has been proposed for controlling AGIB but concerns remain regarding its safety and effectiveness. This meta-analysis aimed to assess the safety and efficacy of TXA in AGIB. Methods: Electronic databases like PubMed, Cochrane Library, and ScienceDirect were searched from inception till January 2025. This review followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The Risk Ratios (RR) and Mean Differences (MD) along with 95% confidence intervals (CI) were pooled under the random effects model using Review Manager version 5.4.1 for the dichotomous and continuous outcomes. The quality was assessed by the Cochrane RoB 2.0 tool and the Newcastle Ottawa Scale. Publication bias was assessed by the funnel plots and Egger’s regression test. Results: Eighteen studies pooling a total of 15,014 patients were included in this meta-analysis. Mortality was significantly reduced in the TXA group with a pooled RR of 0.83 (95% CI: [0.73, 0.95]; P = 0.008; I2 = 0%). Rebleeding risk was also significantly decreased in the TXA arm (RR = 0.75; 95% CI: [0.62, 0.92]; P = 0.005; I2 = 41%). The transfusion requirement (RR = 0.99; 95% CI: [0.93, 1.06]; P = 0.74; I2 = 37%) and the need for overall interventions (RR = 0.87; 95% CI: [0.69, 1.10]; P = 0.25; I2 = 38%) showed no significant difference between the 2 arms . Other outcomes including the need for therapeutic endoscopic intervention (RR = 0.86; 95% CI: [0.62, 1.21]; P = 0.39; I2 = 50%), need for surgical intervention (RR = 0.76; 95% CI: [0.54, 1.07]; P = 0.11; I2 = 47%), venous thromboembolic events (RR = 1.29; 95% CI: [0.53, 3.16]; P = 0.58; I2 = 39%), arterial thromboembolic events (RR = 0.95; 95% CI: [0.64, 1.42]; P = 0.82; I2 = 0%), transfusion volume (MD = -0.64; 95% CI: [-1.37, 0.08]; P = 0.08; I2 = 77%), and length of hospital stay (MD = -0.17; 95% CI: [-0.48, 0.14]; P = 0.28; I2 = 42%) were comparable between the 2 groups. Conclusion: Tranexamic acid significantly reduces mortality and rebleeding in AGIB, but shows no significant differences in transfusion requirements, interventions, or thromboembolic risks, indicating potential benefits with comparable safety.