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 venous thromboembolic events. The use of TXA in GI bleeding is still a topic of debate, with some studies suggesting a potential benefit in reducing mortality and rebleeding rates, while others have found no significant effect 1. However, a more recent and higher-quality study found that TXA had no beneficial effect in patients with acute upper gastrointestinal bleeding, including those with suspected variceal bleeding and liver disease comorbidity, and was associated with an increased risk of venous thromboembolic events 1.
The primary management of GI bleeding should focus on addressing the underlying cause, such as using proton pump inhibitors for peptic ulcers, endoscopic interventions, or other hemostatic measures. TXA may be considered as an adjunctive therapy in certain cases, but its use should be carefully weighed against the potential risks and benefits. Some key points to consider when evaluating the use of TXA in GI bleeding include:
- The specific cause and location of the GI bleed
- The presence of underlying conditions, such as cirrhosis or portal hypertension
- The potential risks and benefits of TXA, including the risk of venous thromboembolic events
- The availability and effectiveness of alternative treatments, such as endoscopic interventions or other hemostatic measures.
In general, the use of TXA in GI bleeding should be approached with caution and carefully individualized to each patient's specific needs and circumstances. The most recent and highest-quality evidence should be consulted to inform treatment decisions, and patients should be closely monitored for potential adverse effects 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.