Can tranexamic acid (TXA) stop an upper gastrointestinal (GI) bleed?

From the Guidelines

Tranexamic acid (TXA) should not be used to stop an upper gastrointestinal (GI) bleed, as it has not been shown to be effective in this setting and may even increase the risk of thromboembolic events 1.

Key Considerations

• The use of TXA in upper GI bleeding has been evaluated in several studies, but the evidence suggests that it does not improve outcomes and may even be harmful in certain patient populations, such as those with cirrhosis and variceal bleeding 1.
• A large randomized controlled trial of 12,009 patients with acute upper GI bleeding found no beneficial effect of TXA on death due to bleeding within the first 5 days, and an increased risk of venous thromboembolic events in the TXA group compared to the placebo group 1.
• The potential risks and benefits of TXA should be carefully considered on a case-by-case basis, taking into account the individual patient's underlying condition, comorbidities, and risk factors for thromboembolic events.

Clinical Implications

• Standard care for upper GI bleeding should focus on prompt initiation of vasoactive therapy, antibiotics, and endoscopic treatment, rather than the use of TXA 1.
• In patients with cirrhosis and active variceal bleeding, the use of TXA is not recommended due to the lack of evidence supporting its effectiveness and the potential for harm 1.
• Further research is needed to fully understand the role of TXA in the management of upper GI bleeding and to identify patient populations that may benefit from its use.

From the Research

Efficacy of Tranexamic Acid in Upper GI Bleed

• The use of tranexamic acid (TXA) in treating upper gastrointestinal (GI) bleeding has been explored in various studies 2, 3.
• A pilot study published in 2003 found that TXA was beneficial as adjunctive therapy in treating major upper GI bleeding in dialysis patients, reducing the rate of early re-bleeding and the need for blood transfusions 2.
• However, a narrative review published in 2021 stated that TXA was not effective in reducing bleeding in upper GI bleeding, although it did reduce bleeding in other surgical and traumatic contexts 3.

Safety and Efficacy Considerations

• The efficacy and safety of TXA vary according to the clinical context, timing of administration, and dose 4, 5.
• Some studies have reported that TXA reduces major bleeding without a significant increase in thrombotic events, while others have raised concerns about the risk of seizures and thrombotic complications 3, 4, 6.
• The optimal dosing of TXA, particularly in patients with chronic renal dysfunction, remains an area of ongoing research and debate 6.

Clinical Applications

• TXA has been found to be effective in reducing bleeding in various clinical contexts, including surgery, trauma, and bleeding disorders 3, 5.
• However, its use in upper GI bleeding remains uncertain, and further research is needed to fully understand its efficacy and safety in this context 2, 3.