Svensk Kirurgi nr 6-20

297 SVENSK KIRURGI • VOLYM 78 • NR 6 • 2020 inom tre timmar från start av blöd- ning. Då blödningsstart vid gastro- intestinal blödning kan vara svår att bestämma, menar man att behand- lingen kan ha satts in för sent. Man menar även att användningen av tranexamsyra bör individualiseras, både avseende vilka som bör få det och även avseende dos. En annan synpunkt som framförts är att den undersökta populationen var för ”frisk” för att ha nytta av tranexam- syra. Då även dessa ”kritiska” förfat- tare anser att tranexamsyra ej bör användas rutinmässigt vid gastroin- testinal blödning, bör man utifrån det aktuella kunskapsläget med rela- tivt gott vetenskapligt stöd kunna avstå från att använda tranexamsyra vid gastrointestinal blödning.  Referenser 1. CRASH-2 trial collaborators. Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant hae- morrhage (CRASH-2): a randomised, placebo-controlled trial. The Lancet; 2010 Jul 3;376(9734):23–32. 2. Qureshi Z, Kidanto H, Vwalika B, Etuk S, Noor S, Ronsmans C, et al. Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an internatio- nal, randomised, double-blind, placebo- controlled trial. The Lancet; 2017 May 27;389(10084):2105–16. 3. CRASH-3 trial collaborators. Effects of tranexamic acid on death, disability, vascular occlusive events and other mor- bidities in patients with acute traumatic brain injury (CRASH-3): a randomised, placebo-controlled trial. The Lancet; 2019 Nov 9;394(10210):1713–23. 4. Oakland K. Changing epidemiology and etiology of upper and lower gastrointesti- nal bleeding. Best Pract Res Clin Gastro- enterol. 2019 Dec;42-43:101610. 5. Blödande magsår. SBU rapport 206. 2011. 6. Gluud LL, Klingenberg SL, Langholz SE. Systematic review: tranexamic acid for upper gastrointestinal bleeding. Aliment Pharmacol Ther. 2008;27(9):752–8. 7. Bennett C, Klingenberg SL, Langholz E, Gluud LL. Tranexamic acid for upper gastrointestinal bleeding. Cochrane Upper GI and Pancreatic Diseases Group, editor. Cochrane database of systematic reviews (Online). 2014 Nov 21;4(11):CD006640. 8. Twum-Barimah E, Abdelgadir I, Gordon M, Akobeng AK. Systematic review with meta-analysis: the efficacy of tranexamic acid in upper gastrointestinal bleeding. Aliment Pharmacol Ther . 2020 May 3;51(11):1004–13. 9. Lee P-L, Yang K-S, Tsai H-W, Hou S-K, Kang Y-N, Chang C-C. Tranexamic acid for gastrointestinal bleeding: A systematic review with meta-analysis of randomized clinical trials. American Journal of Emer- gency Medicine . Elsevier Inc; 2020 Oct 8;:1–11. 10. Kamal F, Khan MA, Lee-Smith W, Sharma S, Imam Z, Jowhar D, et al. Efficacy and safety of tranexamic acid in acute upper gastrointestinal bleeding: meta-analysis of randomised controlled trials. Scand J Gastroenterol. 2020 Oct 28;2(5):1–8. 11. Roberts I, Shakur-Still H, Afolabi A, Akere A, Arribas M, Brenner A, et al. Effects of a high-dose 24-h infusion of tranexamic acid on death and throm- boembolic events in patients with acute gastrointestinal bleeding (HALT-IT): an international randomised, double-blind, placebo-controlled trial. The Lancet .; 2020 Jun 20;395(10241):1927–36. 12. Perner A, Møller MH. Tranexamic acid for severe gastrointestinal bleeding. The Lancet. The Author(s). Published by Else- vier Ltd. This is an Open Access article under the CC BY 4.0 license; 2020 Jun 20;395(10241):1885–6. 13. Erasu V, Novak A. No role for tran- examic acid in the treatment of acute gastrointestinal bleeding. BMJ Evid Based Med. Royal Society of Medicine ; 2020 Oct 21;1:bmjebm–2020–111498. 14. Roberts LN. Tranexamic acid in acute gastrointestinal bleeding – A cautionary tale. J Thromb Haemost. John Wiley & Sons, Ltd; 2020 Aug 28;18(10):2440–3. 15. Gilbert BW, Rech MA. An alternative perspective to just halting tranexamic acid utilization in gastrointestinal blee- ding. Am J Emerg Med. 2020 Sep. Tabell 1. HALT-IT-studien 11 resultat och komplikationer i urval. Tranexamsyra Placebo Risk ratio (n=5956) (n=5981) (95% CI) Reblödning inom 28 dagar 410 (6.8%) 448 (7.5%) 0.92 (0.81-1.05) Mortalitet pga blödning inom 28 dagar 253 (4.2%) 262 (4.4%) 0.97 (0.82-1.15) Total mortalitet inom 28 dagar 564 (9.5%) 548 (9.2%) 1.03 (0.92-1.16) Terapeutisk endoskopi 2542 (42.7%) 2658 (44.5%) 0.96 (0.92-1.00) Terapeutisk radiologisk intervention 74 (1.2%) 89 (1.5%) 0.83 (0.61-1.13) Kirurgisk intervention 146 (2.5%) 158 (2.6%) 0.93 (0.74-1.16) Transfusion 4076 (68.5%) 4129 (69.1%) 0.99 (0.97-1.02) Djup ventrombos och/eller lungemboli 48 (0.8%) 26 (0.4%) 1.85 (1.15-2.98) Kramp 38 (0.6%) 22 (0.4%) 1.73 (1.03-2.93) Forskningsrön