Can tranexamic acid (TXA) stop a gastrointestinal (GI) bleed?

From the Guidelines

Tranexamic acid (TXA) should not be used to stop a GI bleed, especially in patients with cirrhosis and active variceal bleeding, due to the lack of beneficial effect and potential increased risk of thromboembolic events. TXA works by inhibiting fibrinolysis, which helps stabilize blood clots that form at bleeding sites. However, the use of TXA in GI bleeding is still a topic of debate, and recent studies have shown that it may not be effective in stopping GI bleeds, particularly in patients with cirrhosis and variceal bleeding 1. In fact, a large randomized placebo-controlled trial found that TXA did not reduce mortality due to bleeding in patients with acute upper gastrointestinal bleeding, and may even increase the risk of venous thromboembolic events, especially in patients with comorbid liver disease or suspected variceal bleeding 1.

The management of GI bleeding should focus on standard treatments such as proton pump inhibitors, endoscopic interventions, and correction of coagulopathies. In patients with cirrhosis and active bleeding related to portal hypertension, the use of blood products and correction of haemostatic abnormalities should be considered on a case-by-case basis, taking into account the potential risks and benefits 1. Some studies suggest that the use of recombinant factor VIIa may be beneficial in preventing early re-bleeding in high-risk patients with active bleeding at endoscopy, but this is still a topic of debate and more research is needed to confirm its effectiveness 1.

Key points to consider when managing GI bleeding include:

• The use of TXA is not recommended in patients with cirrhosis and active variceal bleeding due to the lack of beneficial effect and potential increased risk of thromboembolic events 1
• Standard treatments for GI bleeding, such as proton pump inhibitors and endoscopic interventions, should be used alongside correction of coagulopathies
• The use of blood products and correction of haemostatic abnormalities should be considered on a case-by-case basis in patients with cirrhosis and active bleeding related to portal hypertension 1
• More research is needed to confirm the effectiveness of recombinant factor VIIa in preventing early re-bleeding in high-risk patients with active bleeding at endoscopy 1.

From the Research

TXA and GI Bleeding

• The use of tranexamic acid (TXA) in gastrointestinal (GI) bleeding has been studied in several trials, with varying results 2, 3, 4.
• A systematic review and meta-analysis published in 2022 found that extended-use high-dose IV TXA did not reduce mortality or bleeding outcomes, but increased adverse events such as deep venous thrombosis, pulmonary embolism, and seizure 2.
• Another study published in 2024 found that TXA did not reduce mortality in patients with acute upper or lower GI bleeding, and may confer an increased risk of seizures 3.
• However, a more recent meta-analysis published in 2025 found that TXA significantly reduced rebleeding rates overall, and was associated with a mortality reduction when administered through both oral and intravenous routes, particularly in cases of upper GI bleeding 4.
• The evidence suggests that TXA may be effective in reducing rebleeding and mortality in certain sub-groups of patients with GI bleeding, but its use should be approached with caution due to the potential risk of adverse events 2, 3, 4.

Adverse Events

• The use of TXA in GI bleeding has been associated with an increased risk of adverse events, including deep venous thrombosis, pulmonary embolism, and seizure 2, 3.
• However, a meta-analysis published in 2025 found that there was no definitive evidence that TXA use is associated with thromboembolic events 4.
• The risk of adverse events should be carefully considered when deciding whether to use TXA in patients with GI bleeding 2, 3, 4.

Study Limitations

• The studies included in the meta-analyses had varying levels of quality and risk of bias, which may affect the reliability of the results 2, 3, 4.
• Further studies are needed to fully understand the effectiveness and safety of TXA in GI bleeding, particularly in different sub-groups of patients 2, 3, 4.
• One study published in 1976 is not relevant to the question of whether TXA can stop a GI bleed, as it discusses the biological significance of cytochrome methylation 5.