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 Considerations
- 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.
- TXA should not be used as a replacement for standard treatments such as endoscopy, fluid resuscitation, and blood transfusions, but rather as a complementary therapy to help stabilize the patient and reduce bleeding.
- The optimal dose and duration of TXA are still being studied, and its use should be under the guidance of a healthcare professional.
Important Notes
- The treatment benefit of TXA for mortality was no longer apparent when the analysis was limited to trials at low risk of bias 1.
- Studies have been too small to assess the effect of TXA on thromboembolic events in the context of GI bleeding 1.
- The evidence for TXA in GI bleeding is based on historic trials, and its extrapolation to modern day care is uncertain, given the routine use of high-dose acid suppression and endoscopic therapy 1.
From the Research
Efficacy of Tranexamic Acid in Gastrointestinal Bleeding
- Tranexamic acid (TXA) has been shown to be beneficial in treating major upper gastrointestinal bleeding in dialysis patients, reducing the rate of early re-bleeding, repeated endoscopic procedures, and blood transfusions needed 2.
- A systematic review and meta-analysis of randomized clinical trials found that TXA significantly reduced the rates of continued bleeding, urgent endoscopic intervention, and mortality in patients with upper gastrointestinal bleeding 3.
- Another systematic review and meta-analysis found that extended-use high-dose IV TXA did not reduce mortality or bleeding outcomes, but low-dose IV/enteral TXA may be effective in reducing hemorrhage and need for surgery 4.
Administration and Dosage
- The efficacy and safety of TXA for the treatment of bleeding differ according to the clinical context, timing of administration, and dose 5.
- Early administration of TXA is important for efficacy, particularly in trauma and postpartum hemorrhage 5.
- A double-blind randomized controlled trial found that intravenous TXA with and without topical administration reduced the need for urgent endoscopy for acute gastrointestinal bleeding 6.
Safety and Adverse Events
- There is evidence of increased risk of venous thrombosis in patients with gastrointestinal bleeding treated with TXA 5.
- High-dose IV TXA has been associated with an increased risk of deep venous thrombosis, pulmonary embolism, and seizure 4.
- No thromboembolic events were documented during the 1-week follow-up in a study of patients treated with TXA for acute gastrointestinal bleeding 6.
Clinical Context
- TXA may be effective in reducing hemorrhage in patients with upper gastrointestinal bleeding, but its effects on lower gastrointestinal bleeding warrant further clarification 3.
- The use of TXA in patients with gastrointestinal bleeding should be individualized, taking into account the clinical context, bleeding risk, and thrombotic risk 5.