• Twitter
  • Facebook
  • Vimeo
  • FCUS Courses
  • Register for FCUS Course
  • Login
Intensive Care Network
  • About Us
    • What is the ICN?
    • The ICN Story
  • Events
  • Podcast Series
    • ICN Activities
      • ICN Hot cases
      • Semantic sMatter
      • ECG Proving Ground
      • Echo Cases
      • SMACC 2013
      • ICU Radiology Cases
      • Game Changing Evidence
  • Regional Networks
    • SIN
    • BIN
  • Exams
    • Primary ANZCA
      • Pharmacology
      • Physiology
    • Primary ACEM
      • Pharmacology
      • Physiology
      • Pathology
      • Anatomy
    • Fellowship CICM
      • Notes
      • Past Papers
    • Fellowship Paeds
      • Approaches to Questions
      • Clinical Exam
      • Core ICU
      • Clinical Governance
      • Medicine
      • Surgery
    • Fellowship ANZCA
      • Notes
      • Past Papers with Answers
  • Resources
    • Links
    • The ICN meta feed
    • Reviews
      • Courses
      • Conferences
      • Websites & Blogs
      • Books & Journals
    • Clinical Resources
      • Clinical Calculators
    • Non-clinical resources
      • Research
  • Discussion Forum
    • Main Page

The future of GI bleeding in the ICU

Home The future of GI bleeding in the ICU
The future of GI bleeding in the ICU

According to a quote variably attributed to Niels Bohr, Yogi Berra, Albert Einstein, Mark Twain and others ‘prediction is difficult; especially about the future’. Nevertheless, in an era of evidence-based medicine, one might surmise that the future of management of GI bleeding in the ICU will be informed by large-scale high quality RCTs. There are a number of such trials on the horizon that give us a pretty good idea of what the future holds. Based on my best-guess of what these trials will show I predict that in the future we will:
1. Use more TXA in patients with GI bleeding.
2. Use less stress ulcer prophylaxis.

The Haemorrhage ALleviation with Tranexamic acid (TXA) – InTestinal system trial (HALT-IT) is a pragmatic trial that will compare TXA to placebo in 8000 participants with clinically significant gastrointestinal bleeding. The rationale for this trial is that decreasing fibrinolysis with TXA will increase clot stability, improve haemostasis, and reduce rebleeding, leading to reduced mortality for patients presenting with GI bleeds. Additional information about the role of TXA will come from a second trial, the EXARHOSE trial, which will investigate the safety and efficacy of TXA in cirrhotic patients with acute upper GI bleeding.

There are two large-scale RCTs comparing proton pump inhibitors to placebo coming soon. The first is the SUP-ICU trial, which is being run by the Scandinavian Critical Care Trials Group. This trial will enrol adult patients with one or more risk factors for upper GI bleeding and has a primary end point of day 90 mortality. The second is the REVISE trial which includes patients who are mechanically ventilated in ICU and expected to be ventilated the day after tomorrow. REVISE has a primary end point of ‘clinically significant GI bleeding’. Together SUP-ICU and REVISE have a combined sample size of over 8000 participants and will help us to better understand the effects of PPI use on mortality risk, GI bleeding risk, VAP risk, and C. diff infection risk. The results of these trials will be complemented by the PIC-UP trial which will investigate the role of stress ulcer prophylaxis in PICU patients and the PEPTIC trial which compares PPIs and H2RBs in mechanically ventilated adults.

the podcast

the slides

The future of GI bleeding in the ICU by Dr Paul Young from SMACC Conference

Subscribe to the ICN Podcast

Subscribe to the SMACC Podcast

Share this
Lessons learnt from management of PUB in ICU by Professor Lars LundellPut a scope in it by Professor Michael Bourke
IPSN – Intensivist Parent Support Network WIN – Women in Intensive Care Network ICN UK ICN NZ ICN WA ICN VIC ICN NSW ICN QLD The ICN Story The Team Jellybean Podcasts ICN Blog SMACC Video SMACC Audio Video ECG Simulator by aclsmedicaltraining BASIC SCIENCE CLINIC Simulation Game Changing Evidence ICU Radiology Echo Guide ECHO Cases Clinical Cases EXAMHELP Jellybean Podcasts ICN Blog SMACC Video SMACC Audio Video CICM Fellowship ANZCA FELLOWSHIP PAEDS FELLOWSHIP EMERGENCY PRIMARY ANAESTHETICS PRIMARY End-o-bed-o-gram

  • About
    •  What is ICN
    •  The Team
    •  ICN NSW
    •  ICN QLD
    •  ICN VIC
    •  ICN WA
    •  ICN NZ
    •  ICN UK
  • Resources
    •  Lung US
    •  Exam Help
    •  Clinical Cases
    •  Echo Cases
    •  Echo Guide
    •  ICU Radiology
    •  Game Changing Evidence
    •  ICN Metafeed
    •  Simulation Resouces
  • Media
    •  SMACC Posters
    •  Audio
    •  Video
    •  Pecha Kuchas
  • Upskill
    •  Clinical Cases
    •  Echo Cases
    •  ICU Radiology
  • Exam Help
    •  End-o-Bed-o-Gram
    •  ICU Primary Exam
    •  CICM Fellowship
    •  ANZCA Fellowship
    •  Paeds Fellowship
    •  Emergency Primary
    •  Anaesthetics Primary

® 2025 The Intensive Care Network || All rights reserved || Disclaimer || Site Map || Contact ICN Support

Log in with your credentials

or     Create an account

Lost your password?

Forgot your details?

I remember my details

Create Account