Journal Club: Stop the Bleeding!
The HALT-IT Trial Collaborators. “Effects of a High-Dose 24-h Infusion of Tranexamic Acid on Death and Thromboembolic Events in Patients with Acute Gastrointestinal Bleeding (HALT-IT): an International Randomised, Double-Blind, Placebo-Controlled Trial.” The Lancet, vol. 395, no. 10241, 2020, pp. 1927–1936., doi:10.1016/s0140-6736(20)30848-5.
This large international, multicenter, randomized, placebo-controlled trial aimed to assess the effects of tranexamic acid (TXA) in patients with gastrointestinal bleeding. In regards to the primary outcome (death due to bleeding within 5 days of randomization), the authors found no benefit to TXA administration in acutely ill GI bleeding patients. A secondary outcome, risk of venous thromboembolic events, was found to be significantly more likely in the TXA group. That being said, the number of patients experiencing this outcome was small (26 in 5956 for TXA group, 17 in 5981 for placebo group). It is questionable if the study was powered to detect such a difference. Regardless, routine use of TXA in GI bleeds is likely ill-advised in light of this evidence.
The CRASH-3 Trial Collaborators. “Effects of Tranexamic Acid on Death, Disability, Vascular Occlusive Events and Other Morbidities in Patients with Acute Traumatic Brain Injury (CRASH-3): a Randomised, Placebo-Controlled Trial.” The Lancet, vol. 394, no. 10210, 2019, pp. 1713–1723., doi:10.1016/s0140-6736(19)32233-0.
This large international, multicenter, randomized, placebo-controlled trial aimed to assess the effects of tranexamic acid in patients with TBI. The primary outcome was head injury-related death in hospital within 28 days of injury in patients with GCS > 3 and bilaterally reactive pupils who randomly assigned within 3 h of injury. The authors did find some mortality benefit in patients with GCS > 8 who were treated before 3 hours post-injury. That being said, the confidence intervals were wide, and some of the secondary outcomes measured (various complications such as stroke) had confidence intervals that, while non-significant, had lower-bounds very close to 1. This study does demonstrate some value in the use of TXA in traumatic head injury; however, the wide confidence intervals and various secondary outcome measures may discourage the routine use of it even in the indicated patient population.
October Journal Club Discussion Leader: John McGlynn, MD (PGY-2)
2019-2020 Academic Year Journal Club Leaders: Sarah Balog, DO (PGY-3); Rose Solomon, MD (PGY-2); David Andonian, MD (Faculty Advisor)