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

From the Guidelines

Tranexamic acid (TXA) should not be used as a first-line treatment to stop a gastrointestinal (GI) bleed, as its benefits in this context are uncertain and it may increase the 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 patients with cirrhosis and variceal bleeding 1.
• A large randomized controlled trial found no beneficial effect of TXA in patients with acute upper gastrointestinal bleeding, and an increased risk of venous thromboembolic events was observed in the TXA group 1.
• The decision to use TXA should be made on a case-by-case basis, taking into account the severity of the bleed, the patient's overall health, and the potential risks and benefits of treatment.

Treatment Approach

• Standard treatments for GI bleeding, such as endoscopy, fluid resuscitation, and blood transfusions, should be used as indicated.
• In patients with cirrhosis and variceal bleeding, the use of vasoactive therapy, antibiotics, and endoscopic treatment is recommended, rather than TXA 1.
• Close monitoring for signs of adverse effects, such as thromboembolic events, is essential when using TXA, if it is used at all.

Dosing and Duration

• If TXA is used, the recommended dose is typically 1 gram intravenously every 8 hours for a limited duration, usually not exceeding 72 hours.
• However, the use of TXA should be approached with caution, and its benefits and risks should be carefully weighed in each individual case.

From the Research

Efficacy of Tranexamic Acid in Gastrointestinal Bleeding

• Tranexamic acid (TXA) has been shown to be effective in reducing the rates of continued bleeding, urgent endoscopic intervention, and mortality in patients with upper gastrointestinal bleeding 2.
• A systematic review and meta-analysis found that TXA significantly reduced the risk of rebleeding and the need for surgery in patients with gastrointestinal bleeding, although the effects on lower gastrointestinal bleeding warrant further clarification 2.
• Another study found that low-dose IV/enteral TXA reduced the risk of rebleeding and the need for surgery, but did not reduce mortality, with moderate certainty 3.

Safety and Adverse Events

• Extended-use high-dose IV TXA did not reduce mortality or bleeding outcomes and increased adverse events, including deep venous thrombosis, pulmonary embolism, and seizure 3.
• There is evidence of increased risk of venous thrombosis in patients with gastrointestinal bleeding treated with TXA 4.
• A case report described the successful use of TXA to achieve hemostasis in a Jehovah's Witness patient with a life-threatening gastrointestinal bleed, with no reported adverse events 5.

Clinical Applications

• TXA should be considered for use in the emergency department setting for patients with trauma and gastrointestinal bleeding, as it has been shown to reduce mortality and improve outcomes 6.
• Selective use of TXA in high-risk patients may be warranted, particularly in gastrointestinal bleeding scenarios where the risk of thromboembolic events is elevated 6.
• Further studies are needed to understand the mechanisms by which TXA provides benefit, optimal modes of administration and dosing, and its effect in some clinical settings, such as spontaneous intracerebral hemorrhage 4.