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EBM verdict
No role for tranexamic acid in the treatment of acute gastrointestinal bleeding
  1. Vishakha Erasu,
  2. Alex Novak
  1. Emergency Department, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
  1. Correspondence to Dr Alex Novak, Emergency Department, Oxford University Hospitals NHS Foundation Trust, Oxford OX3 9DU, UK; alex.novak{at}

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The HALT-IT Trial has shown that tranexamic acid does not improve outcome in acute gastrointestinal bleeding and may instead increase the risk of complications.

Tranexamic acid (TXA) is an antifibrinolytic drug proven to reduce death due to bleeding in trauma,1 postpartum haemorrhage2 and head injury.3 A Cochrane meta-analysis of 1701 patients showed a large reduction in all-cause mortality with the use of TXA in upper gastrointestinal bleeding.4 The HALT-IT trial was planned as an international, multicentre, randomised, double-blind, placebo-controlled trial to evaluate the effect of TXA in acute upper and lower gastrointestinal bleeding.5

The trial was done across 164 hospitals in 15 countries and randomised patients to either receive TXA (1 g loading dose over 10 min followed by 3 g infusion over 24 hours) or placebo (0.9% normal saline). Adults (16 years and older or 18 years and older, depending on national guidance) with clinically significant gastrointestinal bleeding were eligible for inclusion if the responsible clinician was substantially uncertain whether to use TXA for the gastrointestinal bleed. Significant bleeding was defined …

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  • Contributors Both VE and AN played an equal part in the authorship of this article.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; internally peer reviewed.