Efficacity and Safety of Tranexamic Acid in Cirrhotic Patients Presenting With Acute Upper Gastrointestinal Bleeding

• Status: Unknown status
• Trial end date: 2020-04-01
• Target enrollment: 0
• Participant gender: All

Summary

Upper digestive bleeding. Upper gastrointestinal haemorrhage is a common cause of decompensated cirrhosis and is associated with a high mortality rate among cirrhotic patients. Its leading cause is the rupture of gastro-esophageal varices due to portal hypertension. In cirrhotic patients, the management of acute gastrointestinal haemorrhage is challenging as they often present with coagulation (or haemostasis abnormalities) abnormalities such as hyperfibrinolysis, especially when the cirrhosis is decompensated. Beyond life support measures, therapeutic modalities of upper gastrointestinal bleeding rely on both endoscopic and pharmacological interventions. Tranexamic acid (TA) is an antifibrinolytic that may help control the bleeding in this setting, as it showed an unquestionable benefit in other indications. TA has previously been studied in both upper gastrointestinal haemorrhage from any causes and in liver transplantation of cirrhotic patients. However, there is a lack of data to conclude on its effectiveness (or efficiency) in the early treatment of acute bleeding in cirrhotic patients.

Investigators hypothesize that, when given early, TA would be beneficial for cirrhotic patients presenting with acute upper gastrointestinal haemorrhage , by controlling the haemorrhage, avoiding rebleeding episodes and reducing mortality within 5 days after its administration. Moreover, TA could prevent early cirrhosis complications (such as hepatic encephalopathy, sepsis and ascites liquid infection, hepatorenal syndrome), could reduce indications to transjugular portosystemic shunt (TIPS), shorten the length of stay in intensive care unit and the length of hospitalization, and decrease late relapses and one-year mortality.

• Phase: Phase 4
• Accepts Healthy Volunteers?: No

Details

• Lead Sponsor: Assistance Publique - Hôpitaux de Paris
• Treatments: Tranexamic Acid

Criteria

Inclusion Criteria (modified by amendment1)

• Age ≥ 18

• Patient treated by a prehospital physician-staffed SMUR team, a firefighter physician-staffed ambulance (ARBSPP), an hospital EMS or an ICU

• Acute upper digestive bleeding (< 24h) in the shape of hematemesis, described either by the physician, the patient, a relative or a member of the medical team

• Known or suspected cirrhosis (based on clinical/biological/radiographic/anamnestic data)

• Affiliated or recipient of the French social security

• Written consent (or under emergency procedures)

Exclusion Criteria (modified by amendment1)

• Known ongoing pregnancy or breastfeeding

• TA already given (if inter-hospital transfer)

• Endoscopy already performed for the current haemorrhagic episode

• Hospitalization for over 24h in an intensive care unit or a routine care unit

• Exclusive lower digestive bleeding or melena only

• Patient in cardiac arrest at the arrival of the prehospital medical team, whether recovered or not

• Patient already randomised once in EXARHOSE study

• TA Counter-indications

• creatininemia > 500 μmol/L or documented clearance < 30 mL/min

• documented ongoing CIVD (prior to UDB)

• ongoing seizures

• ongoing arterial or venous thrombosis

• allergy

• Known participation of the patient to another therapeutic study

• Known linguistic inability of the patient to understand the study

• Patient under known guardianship