Antifibrinolytic amino acids for upper gastrointestinal bleeding in people with acute or chronic liver disease

Review question
We reviewed antifibrinolytic amino acids for upper gastrointestinal bleeding in people with acute or chronic liver disease.

Background

Upper gastrointestinal bleeding (vomiting of blood) is one of the most frequent causes of illness and death in the course of liver disease. People with liver disease frequently have haemostatic abnormalities, which include hyperfibrinolysis (increased prevention of blood clotting). Antifibrinolytic amino acids have been suggested for the treatment of gastrointestinal emergency, but it is unknown whether they are of benefit or cause harm when used for treating upper gastrointestinal bleeding in people with acute or chronic liver disease.

Study characteristics

We found no randomised clinical trials (studies where people are randomly put into one of two or more treatment groups) for inclusion in this updated review on the benefits and harms of antifibrinolytic amino acids for upper gastrointestinal bleeding in people with liver diseases. The evidence is current to February 2015.

Key results

Accordingly, we cannot recommend or refute antifibrinolytic amino acids for upper gastrointestinal bleeding in people with acute or chronic liver disease.

Quality of evidence

We found no randomised clinical trials.

Authors' conclusions: 

This updated Cochrane review identified no randomised clinical trials assessing the benefits and harms of antifibrinolytic amino acids for upper gastrointestinal bleeding in people with acute or chronic liver disease. The benefits and harms of antifibrinolytic amino acids need to be tested in randomised clinical trials. Unless randomised clinical trials are conducted to assess the trade-off between benefits and harms, we cannot recommend or refute antifibrinolytic amino acids for upper gastrointestinal bleeding in people with acute or chronic liver diseases.

Read the full abstract...
Background: 

Upper gastrointestinal bleeding is one of the most frequent causes of morbidity and mortality in the course of liver cirrhosis. People with liver disease frequently have haemostatic abnormalities such as hyperfibrinolysis. Therefore, antifibrinolytic amino acids have been proposed to be used as supplementary interventions alongside any of the primary treatments for upper gastrointestinal bleeding in people with liver diseases. This is an update of this Cochrane review.

Objectives: 

To assess the beneficial and harmful effects of antifibrinolytic amino acids for upper gastrointestinal bleeding in people with acute or chronic liver disease.

Search strategy: 

We searched The Cochrane Hepato-Biliary Controlled Trials Register (February 2015), Cochrane Central Register of Controlled Trials (CENTRAL) (Issue 2 of 12, 2015), MEDLINE (Ovid SP) (1946 to February 2015), EMBASE (Ovid SP) (1974 to February 2015), Science Citation Index EXPANDED (1900 to February 2015), LILACS (1982 to February 2015), World Health Organization Clinical Trials Search Portal (accessed 26 February 2015), and the metaRegister of Controlled Trials (accessed 26 February 2015). We scrutinised the reference lists of the retrieved publications.

Selection criteria: 

Randomised clinical trials irrespective of blinding, language, or publication status for assessment of benefits and harms. Observational studies for assessment of harms.

Data collection and analysis: 

We planned to summarise data from randomised clinical trials using standard Cochrane methodologies and assessed according to the GRADE approach.

Main results: 

We found no randomised clinical trials assessing antifibrinolytic amino acids for treating upper gastrointestinal bleeding in people with acute or chronic liver disease. We did not identify quasi-randomised, historically controlled, or observational studies in which we could assess harms.

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