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Episode Info: Background: Acute gastrointestinal bleeding (GIB) is a common diagnosis dealt with by emergency clinicians.  Definitive therapy for acute GIB often includes endoscopy or surgery. However, there is a myriad of pharmaceutical options (i.e. PPI, Somatostatin Analogues, Antibiotics, etc.) as well as blood products that may be instituted as part of the acute resuscitation of these patients. The role of tranexamic acid (TXA) in resuscitation of this condition is unknown. TXA has become one of the darling medications of emergency medicine, with numerous indications, minimal side effect profile and low cost. TXA works by inhibiting blood clot breakdown (i.e. fibrinolysis).  TXA has been shown to decrease death from bleeding in other conditions (Trauma, Postpartum hemorrhage) but there is limited evidence for its use in GIB.  A systematic review and meta-analysis of seven randomized trials with just over 1600 patients [2] showed a reduction in all-cause mortality.  However, the individual trials were small and prone to a myriad of biases making these conclusions hypothesis generating at best. REBEL  Cast Episode 85 –  The HALT-IT Trial – TXA in Acute GI Bleeds Click here for Direct Download of Podcast Paper: The HALT-IT Trial Collaborators. Effects of High-Dose 24-h Infusion of Tranexamic Acid on Death and Thromboembolic Events in Patients with Acute Gastrointestinal Bleeding (HALT-IT): An International Randomised, Double-Blind, Placebo-Controlled Trial. Lancet 2020. [Epub Ahead of Print] Clinical Question: Does IV tranexamic acid reduce 5-day death due to bleeding in adult patients with acute gastrointestinal hemorrhage compared to placebo? What They Did: International, multicenter, randomized, placebo-controlled trial in 164 hospitals in 15 countries Patients randomly assigned to: TXA: Loading dose of 1g of TXA in 100mL infusion of 0.9% sodium chloride over 10 min, followed by a maintenance dose of 3g TXA added to 1L of isotonic IV solution infused at 125mg/hr for 24hrs Placebo: Matching 0.9% sodium chloride Outcomes: Primary: Death due to bleeding within 5 days of randomization Analysis excluded patients who received neither dose of the allocated treatment and those for whom data on death were unavailable Secondary: Death due to bleeding within 24h and 28d of randomization All-cause and cause specific mortality at 28d Rebleeding within 24h, within 5d, and within 28d of randomization, surgery or radiological intervention Blood product transfusion Arterial Thromboembolic Events (MI or Stroke) Venous Thromboembolic Events (DVT or PE) Seizures Other complications (including cardiac events, sepsis, pneumonia, respiratory failure, renal failure, liver failure) Days in the ICU Functional status in-hospital or at 28d Inclusion: Clinician uncertain whether to use TXA Older than minimum age to be considered an adult (Either ≥16 years or ≥18 years) Significant upper and/or lower GIB (Defined as risk of bleeding to death) Hypotension Tachycardi...
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