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Nephrol Dial Transplant (2003) 18: 1388-1391
© 2003 European Renal Association-European Dialysis and Transplant Association

Brief Report

Tranexamic acid is beneficial as adjunctive therapy in treating major upper gastrointestinal bleeding in dialysis patients

Miso Sabovic1,, Janez Lavre2 and Bojan Vujkovac2

1 University Medical Centre, Department for Vascular Diseases, Ljubljana and 2 Department of Nephrology and Dialysis, Slovenj Gradec General Hospital, Slovenia

Background. In a pilot, non-randomized trial we tested the efficacy of tranexamic acid (TXA), a potent fibrinolytic inhibitor, as adjunctive therapy in standard treatment of major upper gastrointestinal bleeding in dialysis patients.

Methods. Twenty consecutive patients (12 male, eight female; 63±8 years) with 36 episodes of major upper gastrointestinal bleeding were included in the study. In 16 episodes of bleeding TXA was used (in a dosage of 20 mg intravenously, followed for the next 4 weeks by 10 mg/kg/48 h orally), whereas in 20 other cases of bleeding, TXA was not used. The decision to use TXA was left to the attending physician's clinical judgement, resulting in all the more severe cases of bleeding being treated with TXA.

Results. Treatment including TXA was shown to be beneficial (relative to cases not treated with TXA) in terms of decreasing the rate of early re-bleeding (in the first week, 0 vs 6, P<0.05), the rate of early and late re-bleeding (in the first month, 1 vs 8, P<0.05), the rate of repeated endoscopic procedures (in the first month, 1 vs 8, P<0.05) and the number of blood transfusions needed (in the first month, 1.4±1.3 vs 2.6±1.5 units, P<0.05).

Conclusions. The results of this pilot study suggest that TXA can be beneficial in the treatment of major upper gastrointestinal bleeding in dialysis patients. This remains to be definitely confirmed in a randomized study.

Keywords: dialysis; erosive gastritis; re-bleeding; tranexamic acid; treatment; upper gastrointestinal bleeding

Correspondence and offprint requests to: Miso Sabovic, MD, PhD, Department for Vascular Diseases, University Medical Centre, Riharjeva 24, 1000 Ljubljana, Slovenia. Email: miso.sabovic{at}trnovo.kclj.si


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