Precise Delivery of Tranexamic Acid to Enhance Endoscopic Hemostasis for Peptic Ulcer Bleeding
Status:
Not yet recruiting
Trial end date:
2022-12-31
Target enrollment:
Participant gender:
Summary
Peptic ulcer bleeding is a common emergency for patients who need therapeutic endoscopy.
According to international guidelines and Taiwan consensus, the standard therapy included
proton pump inhibitor (PPI) and endoscopic therapy. For high-risk peptic ulcers, such as
active spurting, oozing bleeding, a nonbleeding visible vessel or ulcers with adherent clots,
we apply endoscopic hemostasis with epinephrine injection in combination with either heater
probe coagulation, hemoclipping and/or rubber band ligation. Parenteral high-dose PPI is
administered after endoscopic hemostasis. Though current standard endoscopic therapy plus PPI
infusion are highly effective, 5%-10% of the patients still experience recurrence of bleeding
after the initial treatment. It is still an important issue to reduce recurrent peptic ulcer
bleeding after standard endoscopic therapy.
Tranexamic acid reduces bleeding by inhibiting clot breakdown by inhibiting the degradation
of fibrin by plasmin. It is effective to be used topically to reduce bleeding during surgery.
However, the effect of application of tranexamic acid orally or intravenously for
gastrointestinal bleeding was still controversial, probably because that the route of
tranexamic acid use is not precise at the bleeding site. Tranexamic acid has
anti-fibrinolytic effects at the bleeding site, so it is possible that use of tranexamic acid
locally may have better efficacy than via intravenous or oral route. We propose to
investigate the effectiveness and safety when using tranexamic acid locally under endoscopic
guidance in patients with peptic ulcer bleeding after standard endoscopic therapy.