AB171. SOH25_AB_055. Audit of tranexamic acid use in non-variceal upper gastrointestinal bleeding: assessing initial management and risk stratification
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AB171. SOH25_AB_055. Audit of tranexamic acid use in non-variceal upper gastrointestinal bleeding: assessing initial management and risk stratification

Osman Abdelhamed, Mohammed Khalifa, Conor Gleeson

Colorectal Surgery Department, St. Vincent’s University Hospital, Dublin, Ireland

Background: Tranexamic acid (TXA) is an antifibrinolytic agent used to control bleeding in various clinical settings. However, its role in non-variceal upper gastrointestinal bleeding (UGIB) is controversial. The European Society of Gastrointestinal Endoscopy (ESGE) does not recommend the routine use of TXA in UGIB, due to insufficient evidence of benefit and concerns about potential risks, including thromboembolic events. This audit assesses the initial management and risk stratification of non-variceal UGIB at St. Vincent’s University Hospital, with a particular focus on the use of TXA.

Methods: This audit reviewed cases of non-variceal UGIB at St. Vincent’s University Hospital from April to June 2024. Patients were included if admitted through the emergency department with documented UGIB. Cases of variceal UGIB, insufficient documentation, or in-hospital deaths were excluded. Key data included initial hemoglobin levels, TXA administration, re-bleeding events, and adherence to ESGE-recommended interventions such as PPI therapy and endoscopic evaluation.

Results: Out of 32 patients with documented UGIB, 12 (37.5%) received TXA, with one case of seizure and no documented venous thromboembolism. Five patients (16%) experienced re-bleeding, including 3 who received TXA. No patients required surgical intervention. Most patients adhered to ESGE guidelines regarding PPI infusion and timely endoscopy, though TXA use deviated from guideline recommendations

Conclusions: The audit indicates good overall adherence to ESGE guidelines, except for TXA use in non-variceal UGIB, which was higher than recommended. The findings highlight the need for local guidelines to standardize TXA use and emphasize risk stratification tools, such as the Glasgow-Blatchford score, in UGIB management.

Keywords: Tranexamic acid (TXA); non-variceal upper gastrointestinal bleeding (non-variceal UGIB); European Society of Gastrointestinal Endoscopy guidelines (ESGE guidelines); risk stratification; adherence to guidelines

Acknowledgments

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Footnote

Funding: None.

Conflicts of Interest: The authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

doi: 10.21037/map-25-ab171
Cite this abstract as: Abdelhamed O, Khalifa M, Gleeson C. AB171. SOH25_AB_055. Audit of tranexamic acid use in non-variceal upper gastrointestinal bleeding: assessing initial management and risk stratification. Mesentery Peritoneum 2025;9:AB171.

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