From the Guidelines
Tranexamic acid (TXA) should not be used to stop a GI bleed, especially in patients with cirrhosis and variceal bleeding, due to the lack of beneficial effect and increased risk of 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 [ 1 ]. However, a more recent and higher-quality study found no beneficial effect of TXA in patients with acute upper gastrointestinal bleeding, including those with suspected variceal bleeding and liver disease comorbidity [ 1 ]. In fact, the study found an increased risk of venous thromboembolic events in the TXA group, particularly in patients with comorbid liver disease or suspected 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 benefits of TXA in reducing mortality and rebleeding rates in certain types of GI bleeding [ 1 ]
- The lack of beneficial effect of TXA in patients with cirrhosis and variceal bleeding, and the increased risk of thromboembolic events [ 1 ]
- The importance of identifying and treating the underlying cause of GI bleeding, such as endoscopic intervention for ulcers or varices, acid suppression with proton pump inhibitors, or correction of coagulopathies.
In terms of specific patient populations, the evidence suggests that TXA should not be used in patients with cirrhosis and variceal bleeding [ 1 ]. However, the use of TXA in other types of GI bleeding, such as mucosal bleeding or bleeding due to gastric vascular ectasia, may be considered on a case-by-case basis. Ultimately, the decision to use TXA in GI bleeding should be based on a careful evaluation of the potential benefits and risks, as well as the individual patient's underlying condition and medical history.
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.