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

From the Guidelines

Tranexamic acid (TXA) should not be used to stop a GI bleed, particularly in patients with cirrhosis and active variceal bleeding, due to the lack of beneficial effect and increased risk of venous thromboembolic events 1. When considering the use of TXA in GI bleeding, it's essential to differentiate between upper and lower GI bleeds, as well as the underlying cause of the bleeding.

• For upper GI bleeds, TXA may be considered as an adjunct therapy in certain cases, but its use should be cautious and based on individual patient risk factors.
• The evidence from the most recent and highest quality study 1 suggests that TXA does not have a beneficial effect in stopping GI bleeds, particularly in patients with cirrhosis and variceal bleeding. Some key points to consider when evaluating the use of TXA in GI bleeding include:
• The mechanism of action of TXA, which involves inhibiting fibrinolysis and stabilizing blood clots 1.
• The potential risks and benefits of TXA, including the increased risk of venous thromboembolic events 1.
• The importance of individualizing treatment decisions based on patient-specific factors, such as underlying liver disease, thromboembolic risk factors, and renal impairment. Overall, the use of TXA in GI bleeding should be approached with caution and based on the most recent and highest quality evidence available 1.

From the Research

Efficacy of Tranexamic Acid in GI Bleeding

• Tranexamic acid (TXA) has been studied as a potential treatment for gastrointestinal (GI) bleeding, with mixed results 2, 3, 4, 5, 6.
• A 2021 systematic review and meta-analysis found that TXA significantly reduced the rates of continued bleeding, urgent endoscopic intervention, and mortality in patients with upper GI bleeding 2.
• Another study published in 2022 found that extended-use high-dose IV TXA did not reduce mortality or bleeding outcomes, but low-dose IV/enteral TXA may be effective in reducing hemorrhage 3.
• A 2024 meta-analysis 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 upper GI bleeding 4.
• However, a 2020 systematic review and meta-analysis found that TXA did not improve outcomes in upper GI bleeding and may increase the risk of venous thromboembolic events 5.
• A 2025 comprehensive systematic review and meta-analysis found that TXA significantly reduced rebleeding rates, particularly in upper GI bleeding, and was associated with a mortality reduction when administered through both oral and intravenous routes 6.

Safety and Adverse Events

• The use of TXA in GI bleeding has been associated with an increased risk of thromboembolic events, including deep venous thrombosis and pulmonary embolism 3, 5.
• However, a 2025 meta-analysis found that there was no definitive evidence that TXA use is associated with thromboembolic events 6.
• The safety and efficacy of TXA in lower GI bleeding are less clear, with one study finding that TXA was linked to a significant increase in mortality in patients with lower GI bleeding 6.

Clinical Implications

• The available evidence suggests that TXA may be a useful adjunctive treatment for upper GI bleeding, particularly when combined with acid suppression 2, 4, 6.
• However, the use of TXA in GI bleeding should be approached with caution, taking into account the potential risks and benefits, as well as individual patient factors 3, 5, 6.