Early Tranexamic Acid Therapy and Its Influence on Hemoglobin Dynamics, Hospital Stay, and ICU Admissions in Upper Gastrointestinal Bleeding

Background Upper gastrointestinal bleeding (UGIB) is a life-threatening emergency associated with substantial morbidity, frequent transfusion needs, and prolonged hospitalization. Tranexamic acid (TXA) may reduce bleeding by stabilizing fibrin clots, but evidence regarding its early use in UGIB remains mixed. Objective This study evaluated whether early TXA administration influences hemoglobin dynamics, hospital stay, and ICU admissions in patients presenting with UGIB. Methods This prospective observational study was conducted at Shifa International Hospital, Islamabad, Pakistan, over 24 months. A total of 220 adult patients with UGIB were enrolled through purposive sampling and divided into two equal groups: an early TXA group receiving intravenous TXA within six hours of presentation (n=110) and a control group receiving standard care (n=110). Baseline demographic and clinical characteristics were similar between groups. Primary outcomes included hemoglobin levels at baseline, 24 hours, 48 hours, and discharge. Secondary outcomes included hospital length of stay, ICU admissions, blood transfusion requirements, and in-hospital mortality. Multivariable regression analyses were performed to adjust for age, comorbidities, baseline hemoglobin, bleeding source, and endoscopic interventions. Results Early TXA significantly preserved hemoglobin at 24 hours (9.2 ± 1.4 vs. 8.5 ± 1.6 g/dL, p < 0.001), 48 hours (8.9 ± 1.3 vs. 8.1 ± 1.5 g/dL, p < 0.001), and discharge (9.0 ± 1.2 vs. 8.2 ± 1.4 g/dL, p < 0.001). Hospital stay was shorter with TXA (5 (4-7) vs. 7 (5-9) days, p < 0.001), and ICU admissions were lower (10.9% vs. 23.6%, p = 0.008). TXA-treated patients required fewer transfusions (1.2 ± 0.8 vs. 2.0 ± 1.1 units, p < 0.001). Mortality was lower but not statistically significant (3.6% vs. 7.3%, p = 0.25). Multivariable analysis confirmed independent associations between early TXA and reduced hemoglobin drop, shorter hospital stay, and lower ICU admission odds. Conclusion Early TXA administration improves hemoglobin preservation, reduces transfusion needs, shortens hospitalization, and lowers ICU admissions in UGIB, supporting its role as an effective early adjunct in acute management.