From the Guidelines
No, Tranexamic Acid (TXA) should not be used to stop a lower gastrointestinal (GI) bleed outside of a clinical trial setting, as its benefit in this context is uncertain and requires further investigation [ 1 ].
Key Considerations
- The use of TXA in acute lower GI bleeding is not supported by strong evidence, and its potential benefits and risks are not well established [ 1 ].
- While TXA has been shown to improve mortality in trauma patients and has some evidence of benefit in acute upper GI bleeding, its effectiveness in lower GI bleeding is unclear [ 1 ].
- The British Society of Gastroenterology suggests that TXA use in acute lower GI bleeding be confined to clinical trials, pending the results of the HALT-IT trial [ 1 ].
Treatment Approach
- A comprehensive treatment plan for lower GI bleeding should prioritize evidence-based interventions, such as endoscopic therapy and high-dose acid suppression [ 1 ].
- The decision to use any medication, including 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.
- Close monitoring of the patient for signs of bleeding cessation or recurrence, as well as for potential adverse effects, is essential in managing lower GI bleeding.
From the Research
Tranexamic Acid (TXA) in Lower Gastrointestinal (GI) Bleeding
- The use of TXA in lower GI bleeding has been studied in several clinical trials, with mixed results 2, 3, 4, 5.
- A randomized placebo-controlled clinical trial found that TXA did not decrease blood loss or improve clinical outcomes in patients with lower GI hemorrhage 5.
- Another study found that TXA was not effective in reducing bleeding in lower GI bleeding 4.
- A systematic review and meta-analysis found that extended-use high-dose IV TXA did not reduce mortality or bleeding outcomes, but increased adverse events, including deep venous thrombosis, pulmonary embolism, and seizure 3.
- Low-dose IV/enteral TXA may be effective in reducing hemorrhage, but more evidence is required to demonstrate its safety 3.
Safety and Efficacy of TXA
- The safety and efficacy of TXA vary according to the clinical context, timing of administration, and dose 2, 6.
- TXA has been shown to reduce bleeding in various surgical procedures, but its use is not yet widespread due to concerns regarding thrombotic risk 6.
- Recent clinical trials and meta-analyses have found that TXA reduces major bleeding by 25% without a significant increase in thrombotic events, but wider use of TXA has the potential to improve surgical safety and avoid unnecessary blood use 6.
- However, there is evidence of increased risk of venous thrombosis in patients with gastrointestinal bleeding, and increased risk of seizures with the use of higher doses of TXA 2, 3.