SP 1.14 Tranexamic Acid in Acute Lower Gastrointestinal Bleeding: A Systematic Review and Meta-analysis of Randomized Evidence

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ID: 324076
2026
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Abstract
Abstract Aims To determine whether tranexamic acid (TXA) improves clinical outcomes or causes harm in patients presenting with acute lower gastrointestinal bleeding (LGIB). Methods A systematic review was conducted of PubMed, Embase, Web of Science, CENTRAL, CINAHL, and Google Scholar from inception to August 2025. Randomized controlled trials (RCTs) and observational cohort studies evaluating TXA in LGIB were included. Primary outcome was 28–30-day mortality. Secondary outcomes included rebleeding, transfusion requirements, need for surgical or radiological intervention, and adverse events. Risk of bias was assessed using RoB 2 and ROBINS-I. Random-effects meta-analysis was performed, reporting risk ratios (RR) or mean differences (MD) with 95% confidence intervals (CI). Results Five studies met inclusion criteria: three RCTs (≈12,200 patients, including the LGIB subgroup of HALT-IT) and two observational cohorts (≈16,500 patients). TXA did not reduce mortality (RR 0.95, 95% CI 0.72–1.25), rebleeding (RR 1.02, 95% CI 0.76–1.38), or transfusion requirements (MD −0.1 units, 95% CI −0.5 to +0.3). No reduction was observed in the need for surgical or radiological intervention. Safety analyses identified a signal toward increased venous thromboembolism and seizures, particularly with high-dose regimens. Conclusions Tranexamic acid provides no clinical benefit in acute lower gastrointestinal bleeding and may be associated with harm. These findings do not support routine TXA use in LGIB. Future research should prioritise adequately powered, LGIB-specific randomized trials rather than extrapolation from mixed gastrointestinal bleeding populations.
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openalex_W7172519904 Use this key to autocite in the manuscript while using SciMatic Manuscript Manager or Thesis Manager
Authors Nauman Ahmed, Shadab Ali
Journal the british journal of surgery
Year 2026
DOI
10.1093/bjs/znag087.018
URL
https://doi.org/10.1093/bjs/znag087.018
Keywords Keywords not found

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