From the Guidelines
The use of tranexamic acid (TXA) is not routinely recommended as a first-line treatment to stop a lower gastrointestinal (GI) bleed due to limited evidence supporting its efficacy in this specific context [ 1 ]. However, in cases where bleeding is suspected to be due to a mucosal disruption or minor vascular injury, a trial of TXA may be considered, with a typical dose of 1 gram orally or intravenously every 8 hours for a maximum of 3 days.
Key Considerations
- The safety and effectiveness of TXA in lower GI bleeding have not been well established [ 1 ], and its use should be individualized and closely monitored.
- TXA is recommended for patients with mild GI bleeding on the basis of low potential for harm, but there is limited evidence of effectiveness [ 1 ].
- Systemic therapies, such as bevacizumab, are recommended for patients with moderate or severe GI bleeding [ 1 ].
Important Notes
- The use of TXA in acute LGIB is currently suggested to be confined to clinical trials, pending the results of the HALT-IT trial [ 1 ].
- Caution should be exercised when using TXA, as the thromboembolic events in the context of GI bleeding have not been well assessed [ 1 ].
From the Research
Efficacy of Tranexamic Acid in Lower Gastrointestinal Bleeding
- The use of tranexamic acid (TXA) in lower gastrointestinal (GI) bleeding has been studied in various clinical contexts, with some evidence suggesting its efficacy in reducing mortality and rebleeding rates 2, 3.
- A meta-analysis of randomized controlled trials found that TXA with acid suppression significantly reduced the risk of rebleeding, units of blood transfused, and the need for salvage therapy in patients with upper GI bleeding 3.
- However, the evidence for TXA in lower GI bleeding is less clear, with some studies suggesting that it may not be beneficial in this context 4.
- It is essential to note that the efficacy and safety of TXA can vary depending on the clinical context, timing of administration, and dose 5.
Safety Considerations
- TXA has been associated with an increased risk of thrombotic events, particularly in patients with gastrointestinal bleeding 5, 2.
- The risk of seizures has also been reported with the use of higher doses of TXA 5.
- Therefore, selective use of TXA in high-risk patients and careful consideration of the potential risks and benefits are warranted 2.
Clinical Context
- The decision to use TXA in lower GI bleeding should be based on individual patient assessment, taking into account the severity of bleeding, underlying medical conditions, and other risk factors 5, 2.
- Further studies are needed to determine the optimal dose and route of TXA administration for lower GI bleeding, as well as to better understand its mechanisms of action and potential benefits and risks in this context 5, 2, 3.