Roland Amathieu

1 Introduction Metformin is a first-line pharmacological treatment for type 2 diabetes mellitus (T2DM) due to its efficacy in improving glycemic control, weight neutrality, and low risk of hypoglycemia (1). It works primarily by inhibiting hepatic gluconeogenesis and improving insulin sensitivity, with most patients tolerating the drug well. However, in rare cases, metformin can lead to a life-threatening condition known as metformin-associated lactic acidosis (MALA).

You are already at the latest version Lactic acidosis is a serious metabolic disorder characterized by an accumulation of lactate in the body, which can lead to a severe acid-base imbalance. Metfor-min-associated lactic acidosis is a rare but life-threatening complication of metformin therapy, particularly in the setting of acute kidney injury or other conditions that im-pair lactate clearance.

Due to poorly described in vivo haemostatic imbalance after UGIB onset in this population, patients will be eligible for 24 hours after the first haematemesis. Regarding the most recent data in non-cirrhotic patients (ie, severe trauma), for whom a time from onset to TXA administration >3 hours showed no clinical benefit in bleeding control, the conclusions of this study might be limited by delayed TXA administration.