From the Guidelines
Yes, Tranexamic Acid (TXA) can be considered as an adjunctive treatment to help stop a gastrointestinal (GI) bleed, particularly in cases of upper GI bleeding, with some evidence suggesting a 40% risk reduction in mortality 1.
Key Points to Consider
- The use of TXA in acute lower GI bleeding is currently suggested to be confined to clinical trials, pending the results of the HALT-IT trial 1.
- The optimal dose and duration of TXA for GI bleeding are still being studied, but it is often given intravenously.
- TXA should be used with caution and in conjunction with standard treatments, such as endoscopy and blood transfusions, as the evidence for its effectiveness in GI bleeding is not as strong as it is for other conditions like trauma and postpartum hemorrhage 1.
- The treatment benefit of TXA for mortality was no longer apparent when the analysis was limited to trials at low risk of bias, highlighting the need for further high-quality research 1.
- Studies have been too small to assess the effect of TXA on thromboembolic events in the context of GI bleeding, which is an important consideration in clinical practice 1.
From the Research
Efficacy of Tranexamic Acid in Gastrointestinal Bleeding
- Tranexamic acid (TXA) has been studied for its effectiveness in treating gastrointestinal (GI) bleeding, with mixed results 2, 3, 4, 5, 6.
- A narrative review found that TXA was not effective in reducing bleeding in upper and lower GI bleeding 2.
- However, a systematic review with meta-analysis found that TXA significantly reduced the rates of continued bleeding, urgent endoscopic intervention, and mortality in patients with upper GI bleeding 3.
- Another study 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 repeated endoscopic procedures 5.
- A randomized controlled trial found that intravenous TXA reduced the need for urgent endoscopy in patients with acute GI bleeding, with no significant differences in mortality, re-bleeding, or blood transfusion rates 6.
Safety Considerations
- The use of TXA in GI bleeding has been associated with an increased risk of thrombotic events, particularly venous thrombosis 2, 4.
- Higher doses of TXA have also been linked to an increased risk of seizures 2, 4.
- However, some studies have found no significant increase in thromboembolic events or other adverse effects with the use of TXA in GI bleeding 3, 5, 6.
Clinical Applications
- The evidence suggests that TXA may be effective in reducing bleeding and improving outcomes in patients with upper GI bleeding, particularly when administered early 3, 5, 6.
- However, the optimal dose and timing of TXA administration, as well as its effectiveness in lower GI bleeding, require further study 2, 3, 4.