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Tranexamic acid in acute gastrointestinal bleeding – A cautionary tale

Gastrointestinal bleeding remains a major global cause of morbidity and mortality. The underlying etiology is heterogenous and generally grouped by site, to upper or lower gastrointestinal tract. Acute, upper gastrointestinal bleeding has a reported annual incidence of 84 to 172 per 100 000. In the United Kingdom alone, this leads to in excess of 50 000 hospital admissions, and an estimated 5000 deaths each year.1,2 Peptic ulcer disease and gastroesophageal varices secondary to liver disease are the most frequent cause. Rebleeding is common (25% post variceal and 10% post nonvariceal bleeds) and is strongly associated with mortality. There has been little change in rebleeding rates and mortality over time, with a need for further strategies to address this.3 Early management includes resuscitation with blood product transfusion, alongside medical, radiological, endoscopic, and surgical intervention. Access to diagnostic and/ or therapeutic investigation is variable and may influence outcome.4 Lower gastrointestinal bleeding is less frequent with an estimated annual incidence of 33 to 87 per 100 000, accounting for 3% of all emergency surgical referrals.5,6 The most common underlying causes are diverticular bleeding and other benign anorectal conditions. Mortality is substantially increased in those with bleeding onset while hospitalized but is most often related to underlying comorbidity, with death directly attributable to bleeding uncommon.7 2 | POTENTIAL ROLE FOR TR ANE X AMIC ACID