Can Tranexamic Acid (TXA) stop a gastrointestinal (GI) bleed?

From the Guidelines

Tranexamic acid (TXA) should not be used as a primary treatment to stop a gastrointestinal (GI) bleed, particularly in cases of variceal bleeding, due to the lack of evidence for its effectiveness and potential increased risk of thromboembolic events 1.

Key Considerations

• The use of TXA in acute GI bleeding has been studied, but the evidence is not strong enough to support its routine use, especially in cases of variceal bleeding 1.
• A large randomized placebo-controlled trial found no beneficial effect of TXA in patients with acute upper gastrointestinal bleeding, including those with suspected variceal bleeding and liver disease comorbidity 1.
• The potential risks of TXA, including an increased incidence of venous thromboembolic events, should be carefully considered, especially in patients with comorbid liver disease or suspected variceal bleeding 1.

Treatment Approach

• Standard treatments, such as endoscopy and blood transfusions, should be used as the primary approach to manage GI bleeding.
• TXA may be considered as an adjunctive treatment in specific cases, but its use should be individualized and carefully weighed against the potential risks and benefits.
• The optimal dose and duration of TXA, if used, are still being studied, and a dose of 1 gram intravenously every 8 hours for a total of 3 doses may be considered, but with caution 1.

From the Research

Effectiveness of Tranexamic Acid in GI 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 4.
• A case report described the successful use of TXA in a Jehovah's Witness patient on apixaban with a life-threatening GI bleed 5.
• A 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 6.

Safety and Adverse Events

• The use of TXA has been associated with an increased risk of thrombotic events, particularly with high-dose IV administration 2, 6.
• A systematic review and meta-analysis found that extended-use high-dose IV TXA resulted in a small increase in deep venous thrombosis, pulmonary embolism, and seizure 6.
• However, low-dose IV/enteral TXA may be safer, with moderate certainty of reducing hemorrhage without increasing adverse events 6.

Dosage and Administration

• The optimal dose and timing of TXA administration for GI bleeding are unclear, with varying dosing strategies used in different studies 2, 3, 4, 5, 6.
• High-dose IV TXA has been associated with increased adverse events, while low-dose IV/enteral TXA may be safer and more effective 6.