HALT-IT TRIAL

Tranexamic Acid in Acute GI Bleed

Friend or Foe?

Dr.Kishalaya Chakraborty

Considering the high mortality associated with GI bleeding(10%) and the 4times high risk of death in case of rebleeding,use of an antifibrinolytic i.e.,Tranexamic acid seems prudent.

This was an International randomised,double-blind,placebo controlled trial done across 164 hospitals in 15 countries and data were collected from July 2013 – June 2019.

12009 patients were randomized.Tranexamic acid(TXA):5956 patients,,,,,Placebo:5981 patients.

TXA was given as 1gm/100ml NS over 1 hour followed by 3gm in 1 litre isotonic solution infused over 24hours in the treatment group.

Outcome:

Primary Outcome:

DEATH DUE TO BLEEDING WITHIN 5 DAYS: TXA(3.7%) vs PLACEBO(3.8%)…

Secondary Outcome:

1. DEATH DUE TO BLEEDING WITHIN 24 HOURS: TXA(2.1%) vs PLACEBO(2.0%).
2. THROMBOEMBOLIC EVENTS: TXA(0.8%) vs PLACEBO(0.4%).
3. TRANSFUSION OF BLOOD PRODUCTS: TXA(68.5%) vs PLACEBO(69.1%).

At the end of the day,statistically speaking the use of TXA in acute GI bleed does not make significant difference in terms of mortality due to bleeding or rebleeding..This pragmatic study could definitely raise ones eyebrows with respect to the risk of thromboembolic events associated with use of TXA(though not significant).

I have TWO questions in my mind though.

1. would TXA have the same effect if it is given to a lower GI bleed from a DIVERTICULUM compared to when given to a patient with upper GI bleed from SEVERE ESOPHAGITIS OR ESOPHAGEAL VARICES.
2. would this study be able to negate the benefits of using TXA in GI bleed cases in centres with limited access to  resources like emergent endoscopy/dedicated blood bank/intervention radiology.

WHAT DO YOU THINK?

Here you go to read the full concept…