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. The use of TXA in acute upper GI bleeding has shown a 40% risk reduction in mortality in pooled analysis of several trials 1. However, it is essential to note that 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, preceding 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.
- The optimal dose and duration of TXA treatment for upper GI bleed are not well established, and further research is needed to determine its effectiveness and safety in this context 1.
- In clinical practice, the use of TXA in upper GI bleeding should be approached with caution, taking into account the potential benefits and risks, as well as the individual patient's clinical scenario and factors 1.
From the Research
Tranexamic Acid (TXA) and Upper GI Bleeding
- The use of TXA in treating upper GI bleeding has been studied in various clinical trials, with some showing beneficial effects 2, 3.
- A pilot study published in 2003 found that TXA reduced the rate of early re-bleeding, late re-bleeding, and the need for blood transfusions in dialysis patients with major upper GI bleeding 2.
- A meta-analysis published in 2024 found that TXA with acid suppression significantly reduced the risk of rebleeding, units of blood transfused, and the need for salvage therapy in patients with upper GI bleeding 3.
- However, a narrative review published in 2021 found that TXA was not effective in reducing bleeding in upper GI bleeding, and noted that there is a risk of thrombotic complications with its use 4.
Efficacy and Safety of TXA
- TXA has been shown to be effective in reducing bleeding in various surgical procedures, including orthopedic, cardiac, and obstetric surgery 5, 6.
- The safety of TXA has been evaluated in several studies, with most finding that it is well-tolerated and associated with few adverse effects 5, 6.
- However, high doses of TXA have been associated with seizures and other adverse effects, and its use should be standardized to minimize risks 6.