# Early Tranexamic Acid Therapy and Its Influence on Hemoglobin Dynamics, Hospital Stay, and ICU Admissions in Upper Gastrointestinal Bleeding

## TL;DR

Early use of tranexamic acid in upper gastrointestinal bleeding helps preserve blood hemoglobin, reduces hospital stays, and lowers ICU admissions.

## Contribution

This study provides empirical evidence supporting early tranexamic acid use in managing upper gastrointestinal bleeding.

## Key findings

- Early TXA significantly preserved hemoglobin levels at 24, 48 hours, and discharge.
- TXA reduced ICU admissions and hospital stay duration in UGIB patients.
- Patients receiving TXA required fewer blood transfusions.

## Abstract

Background

Upper gastrointestinal bleeding (UGIB) is a life-threatening emergency associated with substantial morbidity, frequent transfusion needs, and prolonged hospitalization. Tranexamic acid (TXA) may reduce bleeding by stabilizing fibrin clots, but evidence regarding its early use in UGIB remains mixed.

Objective

This study evaluated whether early TXA administration influences hemoglobin dynamics, hospital stay, and ICU admissions in patients presenting with UGIB.

Methods

This prospective observational study was conducted at Shifa International Hospital, Islamabad, Pakistan, over 24 months. A total of 220 adult patients with UGIB were enrolled through purposive sampling and divided into two equal groups: an early TXA group receiving intravenous TXA within six hours of presentation (n=110) and a control group receiving standard care (n=110). Baseline demographic and clinical characteristics were similar between groups. Primary outcomes included hemoglobin levels at baseline, 24 hours, 48 hours, and discharge. Secondary outcomes included hospital length of stay, ICU admissions, blood transfusion requirements, and in-hospital mortality. Multivariable regression analyses were performed to adjust for age, comorbidities, baseline hemoglobin, bleeding source, and endoscopic interventions.

Results

Early TXA significantly preserved hemoglobin at 24 hours (9.2 ± 1.4 vs. 8.5 ± 1.6 g/dL, p < 0.001), 48 hours (8.9 ± 1.3 vs. 8.1 ± 1.5 g/dL, p < 0.001), and discharge (9.0 ± 1.2 vs. 8.2 ± 1.4 g/dL, p < 0.001). Hospital stay was shorter with TXA (5 (4-7) vs. 7 (5-9) days, p < 0.001), and ICU admissions were lower (10.9% vs. 23.6%, p = 0.008). TXA-treated patients required fewer transfusions (1.2 ± 0.8 vs. 2.0 ± 1.1 units, p < 0.001). Mortality was lower but not statistically significant (3.6% vs. 7.3%, p = 0.25). Multivariable analysis confirmed independent associations between early TXA and reduced hemoglobin drop, shorter hospital stay, and lower ICU admission odds.

Conclusion

Early TXA administration improves hemoglobin preservation, reduces transfusion needs, shortens hospitalization, and lowers ICU admissions in UGIB, supporting its role as an effective early adjunct in acute management.