Abstract / Summary
Tranexamic acid (TXA) is widely used to reduce bleeding in perioperative and hemorrhagic conditions, but its role in upper gastrointestinal bleeding (UGIB) remains controversial. This single-center retrospective cohort study evaluated whether TXA use was associated with reduced progression to clinically important gastrointestinal bleeding (GIB) in critically ill patients with non-clinically important non-variceal UGIB. Adult ICU patients who developed non-clinically important non-variceal UGIB between 2018 and 2022 were included. Among them, 154 patients receiving TXA within 24 h after bleeding onset (mean duration 1.71 ± 1.42 days; mean total dose 2.12 ± 2.36 g) were compared with 1,660 patients who received neither TXA nor other hemostatic agents. After propensity score matching, 154 matched pairs were analyzed. Progression to clinically important GIB did not differ significantly between the TXA and non- TXA groups before matching (5.8% vs. 5.7%; P=0.951, 95% CI: 0.450–1.707) or after matching (5.8% vs. 7.8%; P=0.664, 95% CI: 0.562–3.164); Exploratory univariate conditional logistic regression analysis showed that TXA use was not associated with this outcome (OR 1.333, 95% CI 0.562–3.164; P=0.514). In the matched cohort, TXA was not associated with significant differences in endoscopy requirement, transfusion requirement, hospital length of stay, in-hospital mortality, or thrombotic complications. Inverse probability of treatment weighting analysis yielded consistent results for the primary outcome (5.1% vs. 5.8%; P=0.418, 95% CI: 0.840–1.522). In critically ill patients with non-clinically important non-variceal UGIB, TXA use was not associated with a statistically detectable reduction in progression to clinically important GIB or improvements in major clinical outcomes. Routine empirical use of TXA in this population should be approached with caution.