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Asid tranexamic untuk pendarahan gastrousus atas

Information

DOI:
https://doi.org/10.1002/14651858.CD006640.pub3Copy DOI
Database:
  1. Cochrane Database of Systematic Reviews
Version published:
  1. 21 November 2014see what's new
Type:
  1. Intervention
Stage:
  1. Review
Cochrane Editorial Group:
  1. Cochrane Gut Group

Copyright:
  1. Copyright © 2014 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

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Authors

  • Cathy Bennett

    Centre for Technology Enabled Health Research (CTEHR), Coventry University, Coventry, UK

  • Sarah Louise Klingenberg

    Cochrane Hepato‐Biliary Group, Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark

  • Ebbe Langholz

    Department F, Gastroenterology Section, Gentofte University Hospital, Hellerup, Denmark

  • Lise Lotte Gluud

    Correspondence to: Gastrounit, Medical Division, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark

    [email protected]

Contributions of authors

LLG drafted the review and performed the statistical analyses. SLK and ELA participated in interpretation of the results and revision of the review. All review authors have approved the final version.

Sources of support

Internal sources

  • The present review did not receive funding, Other.

External sources

  • No sources of support supplied

Declarations of interest

None of the review authors has reported any conflicts of interest with regard to the present work.

CB is the proprietor of Systematic Research Ltd and was paid by the CUGPD Editorial Group for her contributions to this review.

Acknowledgements

We would like to thank Dr GM Hawkey (Hawkey 2001), who responded to our request for additional data and Dimitrinka Nikolova of the Cochrane Hepato‐Biliary Group for translations.

Version history

Published

Title

Stage

Authors

Version

2014 Nov 21

Tranexamic acid for upper gastrointestinal bleeding

Review

Cathy Bennett, Sarah Louise Klingenberg, Ebbe Langholz, Lise Lotte Gluud

https://doi.org/10.1002/14651858.CD006640.pub3

2012 Jan 18

Tranexamic acid for upper gastrointestinal bleeding

Review

Lise Lotte Gluud, Sarah Louise Klingenberg, Ebbe Langholz

https://doi.org/10.1002/14651858.CD006640.pub2

2007 Jul 18

Tranexamic acid for upper gastrointestinal bleeding

Protocol

Lise Lotte Gluud, Sarah Louise Klingenberg, Ebbe Langholz

https://doi.org/10.1002/14651858.CD006640

Differences between protocol and review

We updated the review in 2014 to comply with MECIR standards for the conduct and reporting of systematic reviews. We updated the format of the review for clarity and provided the following information about our methods.

  • We included adverse effects as a primary outcome (formerly a secondary outcome) to comply with recent guidance on conduct and presentation of the systematic review.

  • We clarified that because of the risk of selection bias in the allocation of participants to intervention or control groups and bias in the administration of collateral interventions, we did not include cluster‐randomised trials.

  • For trials with multiple intervention groups, we partitioned the numbers of participants in individual allocation arms into pair‐wise comparisons.

  • We used simple imputation to evaluate the potential influence of missing data: imputing failures, imputing successes, worst‐ and best‐case.

  • We provided additional explanations of our assessment and reporting of heterogeneity for clarity; our methods remain unchanged.

  • We performed all meta‐analyses using both random‐effects and fixed‐effect models. Fixed‐effect meta‐analyses are reported only when results of the two models differ (e.g. one model shows no difference between interventions and the other shows an intervention effect).

  • We performed separate analyses of trials on tranexamic acid versus placebo or no intervention and trials on tranexamic acid versus antiulcer drugs. We performed subgroup analyses of trials with low risk of bias based on assessment of the separate domains. We also analysed subgroups of trials that used endoscopic therapy and trials published in English or Russian.

  • We performed an analysis when all participants with missing outcome data were included as treatment failures, and we used a per‐protocol analysis to evaluate the influence of missing data when we excluded participants with missing outcome data.

  • For analyses with at least 10 trials, we planned to assess reporting biases and other dissemination biases on the basis of funnel plots (Higgins 2011) and regression analyses by using Harbord's modified test (Harbord 2006). Our analyses included only eight trials; therefore we did not carry out statistical analysis of reporting bias.

  • We performed a post hoc trial sequential analysis to evaluate the risk of bias associated with cumulative testing and to evaluate futility in assessment of mortality and bleeding (Higgins 2008; Wetterslev 2008). We performed the analysis with power set to 80%, alpha to 5%, model‐based diversity and relative risk reduction (RRR) to 25%. We set the control group incidence to 8% in our analysis of mortality and to 18% in our analysis of bleeding.

  • We prepared a 'Summary of findings' table (Guyatt 2008) using GRADEpro software (Gradepro 3.6) and included information on results of our primary outcomes in relation to risk of heterogeneity, duration of follow‐up and quality of the evidence.

Keywords

MeSH

PICOs

Population
Intervention
Comparison
Outcome

The PICO model is widely used and taught in evidence-based health care as a strategy for formulating questions and search strategies and for characterizing clinical studies or meta-analyses. PICO stands for four different potential components of a clinical question: Patient, Population or Problem; Intervention; Comparison; Outcome.

See more on using PICO in the Cochrane Handbook.

Study flow diagram.
Figures and Tables -
Figure 1

Study flow diagram.

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Figures and Tables -
Figure 2

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

Trial sequential analysis of eight trials on tranexamic acid versus placebo or no intervention. Outcome measure is mortality. Analysis was performed with alpha 5% and power 80%. Model‐based heterogeneity correction was 0%, relative risk reduction 30% and control group incidence 10%. Graph shows the Z‐curve, which is the cumulative result of analysis with trials added according to year of publication. Horizontal line represents 'traditional' 5% level of significance, and inward sloping red line shows trial sequential monitoring boundary. Vertical line represents required information size. Analysis shows that the Z‐curve crosses the trial sequential monitoring boundary, suggesting that the result of the meta‐analysis is confirmed when analysis is adjusted for cumulative testing. Total number of included participants (N = 1701) is only 62% of required information size (N=2714). The meta‐analysis therefore remains inconclusive.
Figures and Tables -
Figure 3

Trial sequential analysis of eight trials on tranexamic acid versus placebo or no intervention. Outcome measure is mortality. Analysis was performed with alpha 5% and power 80%. Model‐based heterogeneity correction was 0%, relative risk reduction 30% and control group incidence 10%. Graph shows the Z‐curve, which is the cumulative result of analysis with trials added according to year of publication. Horizontal line represents 'traditional' 5% level of significance, and inward sloping red line shows trial sequential monitoring boundary. Vertical line represents required information size. Analysis shows that the Z‐curve crosses the trial sequential monitoring boundary, suggesting that the result of the meta‐analysis is confirmed when analysis is adjusted for cumulative testing. Total number of included participants (N = 1701) is only 62% of required information size (N=2714). The meta‐analysis therefore remains inconclusive.

Trial sequential analysis of seven trials on tranexamic acid versus placebo or no intervention. Outcome measure is bleeding. Analysis was performed with alpha 5% and power 80%. Model‐based heterogeneity correction was 53%, relative risk reduction 30% and control group incidence 10%. Graph shows the Z‐curve, which is the cumulative result of analysis with trials added according to year of publication. Horizontal line represents 'traditional' 5% level of significance, and inward sloping red line shows trial sequential monitoring boundary. Vertical line represents required information size. Analysis shows that the Z‐curve does not cross the trial sequential monitoring boundary, and the total number of participants (N = 1651) is 95% of required information size (N = 1734). The meta‐analysis therefore remains inconclusive.
Figures and Tables -
Figure 4

Trial sequential analysis of seven trials on tranexamic acid versus placebo or no intervention. Outcome measure is bleeding. Analysis was performed with alpha 5% and power 80%. Model‐based heterogeneity correction was 53%, relative risk reduction 30% and control group incidence 10%. Graph shows the Z‐curve, which is the cumulative result of analysis with trials added according to year of publication. Horizontal line represents 'traditional' 5% level of significance, and inward sloping red line shows trial sequential monitoring boundary. Vertical line represents required information size. Analysis shows that the Z‐curve does not cross the trial sequential monitoring boundary, and the total number of participants (N = 1651) is 95% of required information size (N = 1734). The meta‐analysis therefore remains inconclusive.

Comparison 1 Tranexamic acid vs placebo, Outcome 1 Mortality.
Figures and Tables -
Analysis 1.1

Comparison 1 Tranexamic acid vs placebo, Outcome 1 Mortality.

Comparison 1 Tranexamic acid vs placebo, Outcome 2 Mortality scenario analysis, treatment failure if participant missing.
Figures and Tables -
Analysis 1.2

Comparison 1 Tranexamic acid vs placebo, Outcome 2 Mortality scenario analysis, treatment failure if participant missing.

Comparison 1 Tranexamic acid vs placebo, Outcome 3 Mortality in trials with low risk of bias.
Figures and Tables -
Analysis 1.3

Comparison 1 Tranexamic acid vs placebo, Outcome 3 Mortality in trials with low risk of bias.

Comparison 1 Tranexamic acid vs placebo, Outcome 4 Mortality in relation to endoscopic therapy.
Figures and Tables -
Analysis 1.4

Comparison 1 Tranexamic acid vs placebo, Outcome 4 Mortality in relation to endoscopic therapy.

Comparison 1 Tranexamic acid vs placebo, Outcome 5 Mortality in relation to language of publication.
Figures and Tables -
Analysis 1.5

Comparison 1 Tranexamic acid vs placebo, Outcome 5 Mortality in relation to language of publication.

Comparison 1 Tranexamic acid vs placebo, Outcome 6 Rebleeding.
Figures and Tables -
Analysis 1.6

Comparison 1 Tranexamic acid vs placebo, Outcome 6 Rebleeding.

Comparison 1 Tranexamic acid vs placebo, Outcome 7 Rebleeding scenario analysis, treatment failure if participant missing.
Figures and Tables -
Analysis 1.7

Comparison 1 Tranexamic acid vs placebo, Outcome 7 Rebleeding scenario analysis, treatment failure if participant missing.

Comparison 1 Tranexamic acid vs placebo, Outcome 8 Rebleeding in trials with low risk of bias.
Figures and Tables -
Analysis 1.8

Comparison 1 Tranexamic acid vs placebo, Outcome 8 Rebleeding in trials with low risk of bias.

Comparison 1 Tranexamic acid vs placebo, Outcome 9 Rebleeding in relation to endoscopic therapy.
Figures and Tables -
Analysis 1.9

Comparison 1 Tranexamic acid vs placebo, Outcome 9 Rebleeding in relation to endoscopic therapy.

Comparison 1 Tranexamic acid vs placebo, Outcome 10 Rebleeding in relation to language of publication.
Figures and Tables -
Analysis 1.10

Comparison 1 Tranexamic acid vs placebo, Outcome 10 Rebleeding in relation to language of publication.

Comparison 1 Tranexamic acid vs placebo, Outcome 11 Myocardial infarction, pulmonary embolism and cerebral infarction.
Figures and Tables -
Analysis 1.11

Comparison 1 Tranexamic acid vs placebo, Outcome 11 Myocardial infarction, pulmonary embolism and cerebral infarction.

Comparison 1 Tranexamic acid vs placebo, Outcome 12 Deep venous thrombosis.
Figures and Tables -
Analysis 1.12

Comparison 1 Tranexamic acid vs placebo, Outcome 12 Deep venous thrombosis.

Comparison 1 Tranexamic acid vs placebo, Outcome 13 Any thromboembolic event.
Figures and Tables -
Analysis 1.13

Comparison 1 Tranexamic acid vs placebo, Outcome 13 Any thromboembolic event.

Comparison 1 Tranexamic acid vs placebo, Outcome 14 Surgery.
Figures and Tables -
Analysis 1.14

Comparison 1 Tranexamic acid vs placebo, Outcome 14 Surgery.

Comparison 1 Tranexamic acid vs placebo, Outcome 15 Transfusion required.
Figures and Tables -
Analysis 1.15

Comparison 1 Tranexamic acid vs placebo, Outcome 15 Transfusion required.

Comparison 2 Tranexamic acid vs cimetidine or lansoprazole, Outcome 1 Mortality.
Figures and Tables -
Analysis 2.1

Comparison 2 Tranexamic acid vs cimetidine or lansoprazole, Outcome 1 Mortality.

Comparison 2 Tranexamic acid vs cimetidine or lansoprazole, Outcome 2 Bleeding.
Figures and Tables -
Analysis 2.2

Comparison 2 Tranexamic acid vs cimetidine or lansoprazole, Outcome 2 Bleeding.

Comparison 2 Tranexamic acid vs cimetidine or lansoprazole, Outcome 3 Surgery.
Figures and Tables -
Analysis 2.3

Comparison 2 Tranexamic acid vs cimetidine or lansoprazole, Outcome 3 Surgery.

Comparison 2 Tranexamic acid vs cimetidine or lansoprazole, Outcome 4 Transfusion.
Figures and Tables -
Analysis 2.4

Comparison 2 Tranexamic acid vs cimetidine or lansoprazole, Outcome 4 Transfusion.

Summary of findings for the main comparison. Tranexamic acid vs placebo for upper gastrointestinal bleeding

Tranexamic acid vs placebo for upper gastrointestinal bleeding

Patient or population: patients with upper gastrointestinal bleeding
Settings:
Intervention: tranexamic acid vs placebo

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

Number of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Control

Tranexamic acid vs placebo

Mortality
Clinical
Follow‐up: median 5 days

Study population

RR 0.6
(0.42‐0.87)

1701
(8 studies)

⊕⊕⊕⊝
moderatea,b

84 per 1000

50 per 1000
(34‐72)

Moderate

83 per 1000

50 per 1000
(34‐71)

Rebleeding
Clinical and endoscopic assessment
Follow‐up: median 5 days

Study population

RR 0.72
(0.50‐1.03)

1651
(7 studies)

⊕⊕⊝⊝
lowa,b,c

177 per 1000

142 per 1000
(113‐177)

Moderate

196 per 1000

157 per 1000
(125‐196)

Any thromboembolic event
Clinical and radiological assessment
Follow‐up: median 5 days

Study population

RR 1.86
(0.66‐5.24)

1095
(4 studies)

⊕⊕⊕⊝
moderatea,b

11 per 1000

20 per 1000
(7‐57)

Moderate

10 per 1000

19 per 1000
(7‐52)

Surgery
Number of participants who underwent surgery
Follow‐up: median 5 days

Study population

RR 0.61
(0.35‐1.04)

1551
(7 studies)

⊕⊕⊕⊝
moderatea

142 per 1000

103 per 1000
(79‐135)

Moderate

154 per 1000

112 per 1000
(86‐146)

Transfusion
Number needing blood transfusion
Follow‐up: median 3 weeks

Study population

RR 1.02
(0.94‐1.1)

931
(5 studies)

⊕⊝⊝⊝
very lowa,d

564 per 1000

558 per 1000
(507‐620)

Moderate

583 per 1000

577 per 1000
(525‐641)

*The basis for the assumed risk (e.g. median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: Confidence interval; RR: Risk ratio.

GRADE Working Group grades of evidence.
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

aMost trials had high risk of attrition bias.
bNot possible to evaluate because number of trials was limited.
cStatistical between‐trial heterogeneity approached 50%.
dThe number of participants who needed transfusion is an indirect measure of bleeding and varies among clinical sites.

Figures and Tables -
Summary of findings for the main comparison. Tranexamic acid vs placebo for upper gastrointestinal bleeding
Summary of findings 2. Tranexamic acid vs cimetidine or lansoprazole for upper gastrointestinal bleeding

Tranexamic acid vs cimetidine or lansoprazole for upper gastrointestinal bleeding

Patient or population: patients with upper gastrointestinal bleeding
Settings:
Intervention: tranexamic acid vs cimetidine or lansoprazole

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

Number of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Control

Tranexamic acid vs cimetidine or lansoprazole

Mortality
Number of participants who died
Follow‐up: median 5 days

Study population

RR 0.91
(0.50‐1.64)

720
(2 studies)

⊕⊕⊕⊝
moderate

61 per 1000

56 per 1000
(31‐101)

Moderate

48 per 1000

44 per 1000
(24‐79)

Rebleeding
Clinical and endoscopic assessment
Follow‐up: median 5 days

Study population

RR 0.87
(0.64‐1.2)

720
(2 studies)

⊕⊕⊕⊝
moderatea,b

188 per 1000

166 per 1000
(121‐226)

Moderate

161 per 1000

142 per 1000
(103‐193)

Surgery
Number of participants who underwent surgery
Follow‐up: median 5 days

Study population

RR 0.83
(0.54‐1.26)

720
(2 studies)

⊕⊕⊕⊝
moderatea,b

139 per 1000

115 per 1000
(79‐168)

Moderate

105 per 1000

87 per 1000
(60‐127)

Transfusion
Number of participants who required at least 1 blood transfusion
Follow‐up: median 5 days

Study population

RR 0.97
(0.78‐1.22)

720
(2 studies)

⊕⊕⊝⊝
lowa,b,c

573 per 1000

579 per 1000
(510‐654)

Moderate

599 per 1000

605 per 1000
(533‐683)

*The basis for the assumed risk (e.g. median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: Confidence interval; RR: Risk ratio.

GRADE Working Group grades of evidence.
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

aHigh risk of bias based on assessment of attrition.
bNot possible to evaluate because number of trials was limited.
cThis outcome measure is a surrogate estimate for bleeding.

Figures and Tables -
Summary of findings 2. Tranexamic acid vs cimetidine or lansoprazole for upper gastrointestinal bleeding
Table 1. Adverse events

Trial

Serious adverse events

Non‐serious adverse events

Non‐serious adverse events

Tranexamic acid

Control group

Intervention group not specified

Tranexamic acid

Control group

Barer 1983

Fatal stroke (n = 1)

Confusion
(n = 1)

Pulmonary embolism (n = 5). Myocardial infarction (n = 8)

None described

Confusion (n = 1)

Biggs 1976

None described

None described

None described

Thrombophlebitis at injection site (n = 3). Nausea or headache (n = 4)

Thrombophlebitis at injection site (n = 2). Nausea or headache (n = 5). Fever (n = 2)

Engquist 1979

Pulmonary embolism (n = 2). Myocardial infarction (n = 2)

Cerebral infarction
(n = 2)

None described

None described

None described

Hawkey 2001

None described

None described

Several participants experienced thromboembolic complications. The numbers were described as not significantly different in treatment and control groups, but no specific data are provided

None described

None described

Holstein 1987

None described

Cerebral infarction
(n = 2)

Five additional participants were excluded as the result of thromboembolic disease, but whether these participants were randomly assigned to tranexamic acid or placebo is not reported

Nausea and vomiting, tachycardia (n = 3). Hypotension (n = 3). Thrombophlebitis at injection site (n = 2). Deep venous thrombosis (n = 1)

None described

Figures and Tables -
Table 1. Adverse events
Comparison 1. Tranexamic acid vs placebo

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Mortality Show forest plot

8

1701

Risk Ratio (M‐H, Random, 95% CI)

0.60 [0.42, 0.87]

2 Mortality scenario analysis, treatment failure if participant missing Show forest plot

8

1701

Risk Ratio (M‐H, Random, 95% CI)

0.88 [0.43, 1.81]

3 Mortality in trials with low risk of bias Show forest plot

8

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

3.1 Allocation sequence generation

1

516

Risk Ratio (M‐H, Random, 95% CI)

0.46 [0.26, 0.82]

3.2 Allocation concealment

7

1654

Risk Ratio (M‐H, Random, 95% CI)

0.61 [0.42, 0.89]

3.3 Blinding

7

1654

Risk Ratio (M‐H, Random, 95% CI)

0.61 [0.42, 0.89]

3.4 Incomplete outcome data

1

206

Risk Ratio (M‐H, Random, 95% CI)

0.8 [0.22, 2.89]

3.5 Selective reporting

7

1651

Risk Ratio (M‐H, Random, 95% CI)

0.60 [0.41, 0.89]

4 Mortality in relation to endoscopic therapy Show forest plot

8

1701

Risk Ratio (M‐H, Random, 95% CI)

0.60 [0.42, 0.87]

4.1 Endoscopic therapy not used

6

1448

Risk Ratio (M‐H, Random, 95% CI)

0.60 [0.40, 0.88]

4.2 Endoscopic therapy used to control bleeding

2

253

Risk Ratio (M‐H, Random, 95% CI)

0.66 [0.22, 2.00]

5 Mortality in relation to language of publication Show forest plot

8

1701

Risk Ratio (M‐H, Random, 95% CI)

0.60 [0.42, 0.87]

5.1 Trials published in English

7

1654

Risk Ratio (M‐H, Random, 95% CI)

0.61 [0.42, 0.89]

5.2 Trials translated from Russian

1

47

Risk Ratio (M‐H, Random, 95% CI)

0.38 [0.04, 3.38]

6 Rebleeding Show forest plot

7

1651

Risk Ratio (M‐H, Random, 95% CI)

0.72 [0.50, 1.03]

7 Rebleeding scenario analysis, treatment failure if participant missing Show forest plot

7

1651

Risk Ratio (M‐H, Random, 95% CI)

0.80 [0.51, 1.27]

8 Rebleeding in trials with low risk of bias Show forest plot

7

5581

Risk Ratio (M‐H, Random, 95% CI)

0.78 [0.65, 0.93]

8.1 Allocation sequence generation

1

516

Risk Ratio (M‐H, Random, 95% CI)

1.16 [0.83, 1.61]

8.2 Allocation concealment

6

1604

Risk Ratio (M‐H, Random, 95% CI)

0.73 [0.50, 1.07]

8.3 Blinding

6

1604

Risk Ratio (M‐H, Random, 95% CI)

0.73 [0.50, 1.07]

8.4 Incomplete outcome data

1

206

Risk Ratio (M‐H, Random, 95% CI)

0.9 [0.38, 2.12]

8.5 Selective reporting

7

1651

Risk Ratio (M‐H, Random, 95% CI)

0.72 [0.50, 1.03]

9 Rebleeding in relation to endoscopic therapy Show forest plot

7

1651

Risk Ratio (M‐H, Random, 95% CI)

0.72 [0.50, 1.03]

9.1 Endoscopic therapy not used

5

1398

Risk Ratio (M‐H, Random, 95% CI)

0.70 [0.45, 1.08]

9.2 Endoscopic therapy used to control bleeding

2

253

Risk Ratio (M‐H, Random, 95% CI)

0.77 [0.36, 1.62]

10 Rebleeding in relation to language of publication Show forest plot

7

1651

Risk Ratio (M‐H, Random, 95% CI)

0.72 [0.50, 1.03]

10.1 Trials published in English

6

1604

Risk Ratio (M‐H, Random, 95% CI)

0.73 [0.50, 1.07]

10.2 Trials translated from Russian

1

47

Risk Ratio (M‐H, Random, 95% CI)

0.45 [0.10, 2.11]

11 Myocardial infarction, pulmonary embolism and cerebral infarction Show forest plot

3

1048

Risk Ratio (M‐H, Random, 95% CI)

1.37 [0.36, 5.28]

12 Deep venous thrombosis Show forest plot

3

1048

Risk Ratio (M‐H, Random, 95% CI)

2.32 [0.60, 8.89]

13 Any thromboembolic event Show forest plot

4

1095

Risk Ratio (M‐H, Random, 95% CI)

1.86 [0.66, 5.24]

14 Surgery Show forest plot

7

1551

Risk Ratio (M‐H, Random, 95% CI)

0.61 [0.35, 1.04]

15 Transfusion required Show forest plot

5

931

Risk Ratio (M‐H, Random, 95% CI)

1.02 [0.94, 1.11]

Figures and Tables -
Comparison 1. Tranexamic acid vs placebo
Comparison 2. Tranexamic acid vs cimetidine or lansoprazole

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Mortality Show forest plot

2

720

Risk Ratio (M‐H, Random, 95% CI)

0.91 [0.50, 1.64]

2 Bleeding Show forest plot

2

720

Risk Ratio (M‐H, Random, 95% CI)

0.87 [0.64, 1.20]

3 Surgery Show forest plot

2

720

Risk Ratio (M‐H, Random, 95% CI)

0.83 [0.54, 1.26]

4 Transfusion Show forest plot

2

720

Risk Ratio (M‐H, Random, 95% CI)

0.97 [0.78, 1.22]

Figures and Tables -
Comparison 2. Tranexamic acid vs cimetidine or lansoprazole