Can Tranexamic Acid (TXA) stop an upper GI (Gastrointestinal) bleed?

From the Guidelines

Yes, Tranexamic Acid (TXA) may be considered as an adjunctive treatment to help stop an upper GI bleed, but it should not be used as a replacement for standard treatment, as the evidence for its benefit in this context is not yet definitive 1.

Key Considerations

• The use of TXA in upper GI bleed is supported by some evidence, including a pooled analysis of several trials showing a 40% risk reduction in mortality 1.
• However, this treatment benefit was no longer apparent when the analysis was limited to trials at low risk of bias, and the studies were considered historic and before the routine use of high-dose acid suppression and endoscopic therapy 1.
• The primary treatment for upper GI bleed should still focus on endoscopic and supportive care, including blood transfusions and medications such as proton pump inhibitors.
• TXA may be considered in addition to these standard treatments, but its use should be individualized and carefully monitored due to potential risks of thromboembolic events 1.

Clinical Decision Making

• In clinical practice, the decision to use TXA in upper GI bleed should be made on a case-by-case basis, taking into account the patient's overall clinical scenario and risk factors.
• The recommended dose of TXA is not explicitly stated in the provided evidence, but it is typically given as 1 gram intravenously every 8 hours for a total of 3 doses, although this may vary depending on the clinical scenario and patient factors.
• It is essential to weigh the potential benefits of TXA against the potential risks and to closely monitor patients for any adverse events.

From the Research

Tranexamic Acid (TXA) in Upper GI Bleeding

• TXA has been studied as a potential treatment for upper gastrointestinal (GI) bleeding, with some studies suggesting its effectiveness in reducing bleeding and improving outcomes 2, 3.
• A 2003 pilot study found that TXA was beneficial in treating major upper GI bleeding in dialysis patients, reducing the rate of early re-bleeding and the need for blood transfusions 2.
• A 2021 narrative review found that TXA was not effective in reducing bleeding in upper GI bleeding, but noted that the evidence was limited and that further studies were needed 4.
• A 2024 meta-analysis of randomized controlled trials found that TXA with acid suppression significantly reduced the risk of rebleeding and the need for salvage therapy in patients with upper GI bleeding 3.

Efficacy and Safety of TXA

• The efficacy and safety of TXA in various clinical settings, including surgery, trauma, and bleeding disorders, have been reviewed in several studies 4, 5, 6.
• TXA has been found to reduce bleeding and improve outcomes in a range of surgical procedures, including hip and knee joint replacement 5.
• However, the use of TXA has also been associated with an increased risk of thrombotic events and seizures in some studies 4, 5.

Clinical Indications for TXA

• TXA has a range of clinical indications, including the treatment of postpartum hemorrhage, menorrhagia, trauma-associated hemorrhage, and surgical bleeding 6.
• The utility of TXA extends beyond these common indications, with accumulating data suggesting its ability to reduce bleeding and improve clinical outcomes in a range of hemostatic challenges 6.