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$  "&("!ob$oG;Cod:'t$t$t2$ԌC!ƻC9't$tb$%=Ģַ!&#=DBt 0@8+,g46d6d 0f ppp@ <4!d!drȷ  <4BdBdȷȷR? %O =8What is the role of tranexamic acid in upper GI bleeding(    By Dr Matt Shepherd  Background  z30,000 admissions in UK / year All case mortality 10% Group who require surgery to control bleeding have 30% mortality z{z Why do ulcers bleed ? 1Vessel erosion Poor clot formation Fibrinolysis#    Fibrinolysis   Plasminogen and plasminogen activators in high concentrations in gastric / duodenal mucosa High levels plasmin in venous effluent Pepsin (also fibrinolytic)v     8     !     Tranexamic Acid   iAntifibrinolytic Inhibits plasminogen / plasminogen activators Inhibits pepsins fibrinolytic properties Xj`              Outcomes ?MORTALITY Needing surgery Rebleeding Transfusion requirement@ 5(     Literature Search S5 Randomised Control Trials Good quality Double Blind Small numbers 1 Meta-analysis.(T(E     Transfusion Requirements     Re-bleeding   Surgery   MORTALITY    Discussion  Poor evidence for a reduction in re-bleeding or transfusion requirements Possibly a reduction in need for surgery but not definite Probable reduction in mortality (impressive reduction in meta-analysis) (((      Discussion  cSmall numbers Few negative trials Very positive trial was largest Poor consistency within trials(Ddc  Conclusion  Need bigger randomised trial to definitely assess benefits. 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P ZB .< s *1 ?0P0ZB /< s *1 ?@ P@ ZB 0< s *1 ?P`B 1< 0o ?`P`H < 0޽h ? ̙334  @\(  @x @ c $A P    @ c $4B <$ 0  H @ 0޽h ? ̙334  D\(  Dx D c $D P    D c $tD <$ 0  H D 0޽h ? ̙334  L\(  Lx L c $4E P    L c $E <$ 0  H L 0޽h ? ̙334  0P\(  Px P c $tG P    P c $G <$ 0  H P 0޽h ? ̙334  PX\(  Xx X c $TI P    X c $I <$ 0  H X 0޽h ? ̙33 KCpd(  d d C AC:\Program Files\Common Files\Microsoft Shared\Clipart\cagcat50\BD06663_.WMF ` d 0K- W Questions (2     d 0L` ,$D  0 n"Easy ones only& & . 2 H d 0޽h ? ˽"i6ffff  0 ](  X  C    B  S ds @  B _Ulcers bleed due to these reasons The first two are hard to do anything about, apart from not iatrogenically causing ulcers with drugs etc. The third mechanism fibrinolysis , the lysis of the vital clot is what I am interested in. \^  3     . H  0޽h ? ̙33V  0 H(  HX H C     H S D @   HDid large +ive trial unduly influence the meta-analysis. Consistency poor  if was reduction in mortality often no reduction in rebleeding /blood requirements etc.D   r    H H 0޽h ? ̙33 0 B:@T(  TX T C    : T S H @   Patients all entered into trials on an intention to treat basis with a primary diagnosis of acute upper gi bleeding. No selection criteria ,h  ! H T 0޽h ? ̙33X 0 `h(  hX h C     h S ės @   bIntroduce self and talk Look at the evidence for the use of tran acid in patients with GI bleeding,<  ! H h 0޽h ? ̙33 0 F>l(  lX l C    s> l S Ds @  B GI bleeding is a common problem Primary A&E presentation Often in elderly/patients with poor cadiovasc reserves. 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&Gy& --iyH-- Times New Roman|wgw  - f.%2 }What is the role of 7. f.2 @ tranexamic-. f.-2 eacid in upper GI bleeding*.--Q1-- fTimes New Roman|wgw2 - . 2 By. .2 FDr Matt Shepherd & .--"Systemwf  -&TNPP &՜.+,D՜.+,D    On-screen Shown-s5j Times New RomanPulse9What is the role of tranexamic acid in upper GI bleeding BackgroundWhy do ulcers bleed ?No Slide TitleFibrinolysis Tranexamic Acid OutcomesLiterature SearchTransfusion Requirements Re-bleedingSurgery MORTALITY Discussion Discussion Conclusion ConclusionsRecommendationNo Slide Title  Fonts UsedDesign Template Slide Titles(RZ _PID_GUID _PID_HLINKSAN{3731C0BE-80DA-11D5-AF7A-00D0B7B51A9A}A6Ghttp://www.harlingen.tstc.edu/biology/jmartinez/BLOOD-FINAL/sld001.htmGhttp://www.harlingen.tstc.edu/biology/jmartinez/BLOOD-FINAL/sld085.htmGhttp://www.harlingen.tstc.edu/biology/jmartinez/BLOOD-FINAL/sld087.htmGhttp://www.harlingen.tstc.edu/biology/jmartinez/BLOOD-FINAL/sld093.htmFhttp://www.harlingen.tstc.edu/biology/jmartinez/BLOOD-FINAL/index.htm/http://hadl.harlingen.tstc.edu/users/jmartinezHhttp://www.harlingen.tstc.edu/biology/jmartinez/BLOOD-FINAL/tsld086.htmA:\sld087.htmA:\sld085.htm_?pauli