Can Tranexamic Acid (TXA) stop an upper gastrointestinal hemorrhage?

From the Guidelines

Tranexamic acid (TXA) is not typically recommended as a first-line treatment for upper gastrointestinal (GI) bleeds, as its effectiveness for this condition is not well-established, and it should not be relied upon as the primary intervention, according to the most recent and highest quality study 1.

Standard Approach for Managing Upper GI Bleeds

The standard approach includes:

• Intravenous proton pump inhibitors (e.g., pantoprazole 80 mg IV bolus, followed by 8 mg/hour infusion)
• Fluid resuscitation and blood transfusions as needed
• Endoscopic intervention to identify and treat the source of bleeding

Consideration of TXA

TXA might be considered as an adjunct therapy in certain cases, particularly if other treatments are not immediately available or have failed. However, it should not replace standard care. If TXA is used, a typical dosing regimen might be 1 gram IV over 10 minutes, followed by 1 gram IV over 8 hours, but this should only be administered under close medical supervision and in conjunction with other appropriate treatments, as suggested by 1.

Second-Line Interventions

Second-line interventions for persistent upper GI bleeds may include:

1. Repeat endoscopy
2. Angiographic embolization
3. Surgical intervention

Always prioritize established treatments and consult with a gastroenterologist or other appropriate specialist for management of upper GI bleeds, as recommended by 1.

From the Research

Efficacy of Tranexamic Acid in Upper Gastrointestinal Hemorrhage

• Tranexamic acid (TXA) has been studied as a potential treatment for upper gastrointestinal bleeding (UGIB) in several clinical trials 2, 3, 4, 5, 6.
• A randomized clinical trial published in 2023 found that TXA was associated with a lower rate of rebleeding and hospitalization time in patients with massive upper GIB, without significant adverse effects 2.
• A meta-analysis of randomized controlled trials 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 UGIB 3.
• Another study published in 2024 found that TXA does not reduce mortality in patients with acute upper or lower gastrointestinal bleeding and may confer an increased risk of seizures 6.
• The use of TXA in UGIB is still a topic of debate, with some studies suggesting its potential benefits and others raising concerns about its safety and efficacy 4, 5.

Safety and Adverse Effects of Tranexamic Acid

• The safety profile of TXA in patients with UGIB has been evaluated in several studies, with some reporting no significant adverse effects 2, 3.
• However, other studies have raised concerns about the potential increased risk of venous thrombosis and seizures associated with TXA use in patients with gastrointestinal bleeding 5, 6.
• The optimal dose and route of TXA administration for the treatment of UGIB are still unclear and require further study 3, 5.

Clinical Implications and Future Directions

• The current evidence suggests that TXA may be a useful adjunctive treatment for UGIB, particularly when combined with acid suppression 3.
• However, further studies are needed to fully understand the efficacy and safety of TXA in this context, as well as to determine the optimal treatment strategies for patients with UGIB 2, 4, 5, 6.