Old/New: HALT-IT and TXA in GI Bleed with cirrhosis
Apr 23, 2024
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Explore the benefits of using tranexamic acid in managing upper gastrointestinal bleeding in cirrhosis patients based on the HALT-IT study findings. Delve into the use of tranexamic acid in critical care, analyzing the design, outcomes, and implications for patient groups. Discuss the enrollment triggers for drug use post-HALT-IT study and interpret relative risk increase in GI bleed with cirrhosis for accurate treatment decisions.
40:48
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Quick takeaways
Transamic acid shows potential mortality benefit in cirrhosis GI bleeds.
TXA use in cirrhosis GI bleeds may decrease re-bleeding instances.
Deep dives
Study on Transamic Acid for GI Bleeds in Cirrhosis Patients
A significant portion of patients with cirrhosis, experiencing GI bleeds, could benefit from transamic acid treatment based on the study. The trial highlighted a potential mortality benefit and reduced re-bleeding rates with this intervention in patients with child's Tercot-Pugh stage B and C cirrhosis. However, the trial, conducted in a single center, did not significantly impact blood product usage.
Efficacy of TXA in Upper GI Bleeds and Cirrhosis Patients
The study demonstrated a positive outcome with a decrease in treatment failure rates in patients receiving TXA compared to a placebo in the management of upper GI bleeds in cirrhosis patients. Although no significant differences were observed in all-cause mortality, there was a notable trend towards reduced re-bleeding instances.
Comparative Analysis of Trial Outcomes
The study results added to the existing body of evidence regarding transamic acid use in variceal bleeding patients. While the trial highlighted potential benefits in terms of treatment failure rates, mortality rates, and re-bleeding instances, inconsistencies in consistent transfusion rates among patients suggested a need for further investigation and adjustments in practice protocols.
Balancing Clinical Practice Guidelines with Trial Findings
The findings prompt a reconsideration of the trigger points for initiating transamic acid treatment in cirrhosis patients with GI bleeds. Evaluation of patient selection criteria, including those at risk for venous thromboembolism and seizures, might help tailor the intervention more effectively to enhance outcomes post-endoscopy and subsequent interventions.
Episode 36! In this episode we talk about tranexamic acid in GI bleeds. We flip the script a little bit and talk about our OLD article first, HALT-IT or "Tranexamic acid in upper gastrointestinal bleed in patients with cirrhosis: A randomized controlled trial" published in Lancet in 2020. This sets the stage for our new trial "Tranexamic acid in upper gastrointestinal bleed in patients with cirrhosis" published in Kumar et al in Hepatology (a new journal for us!)
HALT-IT: https://pubmed.ncbi.nlm.nih.gov/32563378/ TXA and cirrhosis: https://pubmed.ncbi.nlm.nih.gov/38441903/
If you enjoy the show be sure to like and subscribe, leave that 5 star review! Be sure to follow us on the social @icucast for the associated figures, comments, and other content not available in the audio format! Email us at icuedandtoddcast@gmail.com with any questions or suggestions! Thank you Mike Gannon for the intro and exit music!
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