HALT-IT – TXA for GI Bleed

Written by Clay Smith

Spoon Feed
TXA did not reduce mortality within 5 days in patients with upper or lower GI bleeding, but it did increase risk of venous thromboembolism.

Why does this matter?
TXA reduces risk of death from traumatic hemorrhage. Might it also work for GI bleeding?

HALT-IT…or not
This was a large, multi-center randomized, double-blinded, placebo controlled trial of 12,009 patients with upper or lower GI bleeding comparing TXA vs placebo/usual care. For the primary outcome of mortality within 5 days, there was no difference; both had 4% mortality. There was no increase in arterial thrombotic events but nearly double the risk of venous thromboembolism in the TXA group (0.8% TXA vs 0.4% placebo; RR 1·85, 95%CI 1.15 to 2.98). Some interventions help GI bleeds, just not TXA.

Source
Effects of a 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 Jun 20;395(10241):1927-1936. doi: 10.1016/S0140-6736(20)30848-5.

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