Gastrointestinal Bleeding

Gastrointestinal (GI) bleeding is a common emergency that causes substantial mortality and morbidity worldwide.

The common causes of upper GI bleeding are peptic ulcer, oesophageal varices and erosive mucosal disease. Acute upper GI bleeding accounts for about 60,000 hospital admissions each year in the UK and causes the death of about 10% of these patients. Lower GI bleeding accounts for a further 15,000 admissions each year with a case fatality of about 15%. GI bleeding is also common in low and middle-income countries, where patients are usually young and poor.

The source of bleeding is often varices. Re-bleeding occurs in about 10% of patients with non-variceal bleeding and up to 25% of those with variceal bleeding. Mortality is four times higher in patients who re-bleed. An effective, widely practicable and affordable treatment for GI haemorrhage could save many thousands of lives worldwide.

Current Research

The HALT-IT trial is a large, international, randomised, placebo controlled trial, that will determine the effect of early administration of tranexamic acid on mortality, morbidity (re-bleeding, non-fatal thromboembolic events), blood transfusion, surgical intervention and health status in patients with significant GI bleeding. Eight thousand adults with acute significant upper or lower GI bleeding will be randomised to receive TXA or matching placebo. The diagnosis of significant bleeding is clinical but may include patients with hypotension, tachycardia, or those likely to need transfusion, urgent endoscopy or surgery. The fundamental eligibility criterion is the responsible clinician’s ‘uncertainty’ as to whether or not to use TXA in a particular patient with GI bleeding. If the clinician believes there is a clear indication for, or clear contraindication to TXA use, the particular patient should not be randomised.

Resources

All Videos

26. 06. 2017

HALT-IT trial training video

This video describes the trial procedures of the HALT-IT trial, an international, randomized, double-blind, placebo-controlled trial to determine the effect of early administration of TXA on mortality, morbidity (re-bleeding, non-fatal vascular events), blood transfusion, surgical intervention and health status in patients with acute gastrointestinal bleeding.

26. 06. 2017

HALT-IT trial scientific overview

Professor Sir Ian Gilmore, Dr Andrew Veitch, Professor Tim Coats, Haleema Shakur and Dr Ian Roberts explain the rationale and the importance of the HALT-IT trial

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