The University of Toledo Translation Journal of Medical Sciences 
Internal Medicine Abstract, Department of Medicine Research Symposium UTJMS 2023 May 5; 11(1):e1-e1 

The Role of Tranexamic Acid Use in Reducing Mortality 
in Acute Upper GI Bleeding: A Systemic Review and 
Meta-analysis 

Wasef Sayeh, MD1*, Sami Ghazaleh, MD2, Azizullah Beran, MD1, Mohammad Safi, 
MD1, David Farrow, MD1, Sudheer Dhoop, MD1,  Dipen Patel, MD, MBA1, Justin 
Chaung, MD1, Waleed Khokher, MD1, Omar Sajdeya, MD1, Sara Stanley; DO2, 
Muhammad Aziz, MD2, Yaseen Alastal, MD1

1Division of , Department of Medicine, The University of Toledo, Toledo, OH 43614 
2Division of, Department of Medicine, The University of Toledo, Toledo, OH 43614 
3Division of, Department of Medicine, The University of Toledo, Toledo, OH 43614 

*Corresponding author: wasef.sayeh@utoledo.edu

Published: 05 May 2023 

Introduction: Tranexamic acid (TXA) prevents fibrinolysis and is utilized in surgical setting to prevent trauma 
bleeding. The use of TXA in acute UGIB has been evaluated in numerous studies but without conclusive evidence 
on its mortality benefits. 

Methods: We performed a comprehensive search of the databases: PubMed/MEDLINE, Embase, and the 
Cochrane Central Register of Controlled Trials from inception through May 15th, 2022. We considered only 
randomized controlled trials. The primary outcome was the all-cause of mortality rate. The secondary outcomes 
were the refractory bleeding and the need of endoscopic intervention. The random-effects model was used to 
calculate the risk ratios (RR) and 95% confidence intervals (CI). A p value <0.05 was considered statistically 
significant.  

Results: Twelve randomized controlled trials involving 14,100 patients were included in the meta-analysis. The 
mortality rate which was significantly lower in patients who received TXA (4.6% vs 5.3%, RR 0.73, 95% CI 
0.58-0.93, p=0.01, I2 = 17%) (Figure 1a). The rate of refractory bleeding was also lower in the same group 
(10.6% vs 21.1%, RR 0.57, 95% CI 0.37-0.87, p =0.009, I2 = 43%) (Figure 1b). There was no statistical 
difference in the rate of requiring endoscopic intervention (40.3% vs 42.5%, RR 0.95, 95% CI 0.75-1.20, p =0.67, 
I2 =23%) (Figure 1c).  

Discussion: Our meta-analysis demonstrated that the all-cause mortality rate was significantly lower in the 
patients with acute UGIB who received TXA. Moreover, the rate of refractory UGIB was lower in patients who 
were given TXA. TXA maybe utilized clinically in patients presenting with UGIB. 

https://dx.doi.org/10.46570/utjms.vol11-2023-723 

https://dx.doi.org/10.46570/utjms.vol11-2023-723
mailto:wasef.sayeh@utoledo.edu