London School of Hygiene and Tropical Medicine, London, UK.
Department of Emergency Medicine, Sidra Medicine, Doha, Qatar.
Aliment Pharmacol Ther. 2020 Jun;51(11):1004-1013. doi: 10.1111/apt.15761. Epub 2020 May 3.
Upper gastrointestinal bleeding is a common medical emergency associated with substantial mortality. Tranexamic acid may be effective for reducing mortality in upper gastrointestinal bleeding.
To examine the effects of tranexamic acid in upper gastrointestinal bleeding by systematic review and meta-analysis.
We searched PubMed, EMBASE, CINAHL, the Cochrane Central Register of Controlled Trials (CENTRAL) and other relevant websites for randomised controlled trials investigating the effect of tranexamic acid published from inception to December 10, 2019. The primary outcome of interest was mortality. Estimates of effect were pooled with a random effects model. Quality of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach.
The search identified 1572 citations. Eleven trials comprising 2076 patients were eligible for inclusion. Of these, 10 trials (2013 patients) compared tranexamic acid with placebo. Risk of death was significantly reduced in patients who received tranexamic acid compared with those who received placebo (RR 0.59, 95% CI 0.43-0.82, P = 0.001) with no significant heterogeneity noted among studies (I = 0%, P = 0.81). The GRADE assessment rated the quality of the evidence for mortality as moderate due to risk of bias. There were no statistically significant differences between tranexamic acid and placebo for the prevention of re-bleeding, need for surgical interventions, need for blood transfusions or frequency of thromboembolic events.
Moderate-quality evidence shows that tranexamic acid is superior to placebo for the reduction in mortality in patients with upper gastrointestinal bleeding. While our findings lend further support to the use of tranexamic acid for treating patients with upper gastrointestinal bleeding, additional higher-quality trials are needed.
上消化道出血是一种常见的医疗急症，死亡率较高。氨甲环酸可能有助于降低上消化道出血的死亡率。
通过系统评价和荟萃分析来检验氨甲环酸在上消化道出血中的作用。
我们检索了 PubMed、EMBASE、CINAHL、Cochrane 中央对照试验注册库（CENTRAL）和其他相关网站，以获取截至 2019 年 12 月 10 日发表的关于氨甲环酸治疗上消化道出血效果的随机对照试验。主要观察终点为死亡率。使用随机效应模型对效应进行汇总。使用推荐评估、制定与评价（GRADE）方法评估证据质量。
检索到 1572 条引文。11 项试验（2076 例患者）符合纳入标准。其中 10 项试验（2013 例患者）比较了氨甲环酸与安慰剂。与安慰剂相比，接受氨甲环酸治疗的患者死亡风险显著降低（RR 0.59，95%CI 0.43-0.82，P=0.001），且各研究间无显著异质性（I²=0%，P=0.81）。死亡率的证据质量被评估为中等质量，原因是存在偏倚风险。氨甲环酸与安慰剂在预防再出血、手术干预需求、输血需求或血栓栓塞事件发生率方面无统计学差异。
中等质量证据表明，氨甲环酸可降低上消化道出血患者的死亡率，优于安慰剂。虽然我们的研究结果进一步支持氨甲环酸治疗上消化道出血患者，但仍需要更多高质量的试验。
