From the Guidelines
Tranexamic acid (TXA) may have a role in stopping GI bleeding, but its use should be confined to clinical trials or specific scenarios due to uncertain benefits and potential risks. TXA works by inhibiting the breakdown of blood clots, which can reduce bleeding in some cases 1. For acute GI bleeding, several trials of TXA have been carried out, which on pooled analysis showed a 40% risk reduction in mortality 1. However, this treatment benefit for mortality was no longer apparent when the analysis was limited to trials at low risk of bias 1.
Some key points to consider when evaluating the use of TXA for GI bleeding include:
- The potential benefit of TXA in reducing mortality from GI bleeding is uncertain and may not be applicable to modern day care 1
- The use of TXA in acute lower GI bleeding is currently suggested to be confined to clinical trials, pending the results of the HALT-IT trial 1
- TXA may promote thrombotic events, especially in patients with high thromboembolic risk, which must be balanced against its potential benefits 1
- The primary treatments for GI bleeding typically include endoscopic interventions, proton pump inhibitors, and addressing the underlying cause, with TXA potentially used as an adjunctive treatment in specific scenarios 1
In terms of dosing, TXA is sometimes used at doses of 1g IV every 6-8 hours or 1-1.5g orally every 6-8 hours for upper GI bleeding 1. However, the optimal dosing regimen for GI bleeding is not well established and may vary depending on the specific clinical scenario. Overall, the use of TXA for GI bleeding should be approached with caution and as part of a comprehensive approach to bleeding management.