From the Guidelines
Tranexamic acid (TXA) is not routinely recommended for the management of upper gastrointestinal (GI) bleeding due to limited and uncertain evidence of its effectiveness in this setting 1.
Key Points
- The use of TXA in acute GI bleeding has shown a 40% risk reduction in mortality in pooled analysis, but this benefit was not apparent in trials with low risk of bias 1.
- The current evidence is considered historic and outdated, as it was obtained before the routine use of high-dose acid suppression and endoscopic therapy, making its extrapolation to modern day care uncertain 1.
- There is a lack of data on the effect of TXA on thromboembolic events in the context of GI bleeding, which is a significant concern 1.
- The primary treatment for upper GI bleeding should still focus on endoscopic and supportive care, including the use of proton pump inhibitors, blood transfusions, and endoscopic interventions as needed.
Considerations for Use
If TXA is considered as an adjunctive therapy in cases where standard treatments are not available or effective, it should be used with caution and under close monitoring. However, there is no established dosing regimen for TXA in this setting, and its use should be individualized and based on the specific clinical scenario.
From the FDA Drug Label
12 CLINICAL PHARMACOLOGY
- 1 Mechanism of Action Tranexamic acid is a synthetic lysine amino acid derivative, which diminishes the dissolution of hemostatic fibrin by plasmin.
The FDA drug label does not answer the question.
From the Research
Role of Tranexamic Acid in Upper GI Bleeding
- Tranexamic acid (TXA) has been studied for its potential role in managing upper gastrointestinal (GI) bleeding, with some studies suggesting it may be effective in reducing mortality and rebleeding rates 2, 3, 4.
- A systematic review and meta-analysis published in 2021 found that TXA significantly reduced the rates of continued bleeding, urgent endoscopic intervention, and mortality compared to placebo 2.
- Another study published in 2015 found that TXA probably decreases rebleeding and mortality without increasing thromboembolic adverse effects in patients with upper GI bleeding 3.
- A 2020 systematic review and meta-analysis found that TXA was superior to placebo for reducing mortality in patients with upper GI bleeding, with moderate-quality evidence 4.
Efficacy and Safety of Tranexamic Acid
- The efficacy and safety of TXA in acute upper GI bleeding have been evaluated in several studies, with conflicting results 5, 6.
- A 2020 meta-analysis found that TXA did not improve outcomes in upper GI bleeding and may increase the risk of venous thromboembolic events 6.
- In contrast, other studies have found that TXA may reduce mortality and rebleeding rates without increasing the risk of thromboembolic events 2, 3, 4.
Clinical Implications
- The use of TXA in upper GI bleeding may be beneficial in reducing mortality and rebleeding rates, but the evidence is not uniform and more studies are needed to fully understand its effects 2, 5, 3, 4, 6.
- Clinicians should consider the potential benefits and risks of TXA when making treatment decisions for patients with upper GI bleeding, and further research is needed to clarify its role in this setting 2, 5, 3, 4, 6.