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 1.
GI Bleeding Management
When managing GI bleeding, it's essential to consider the underlying cause and severity of the bleed. For upper GI bleeds, standard treatments like proton pump inhibitors, endoscopic interventions, and blood product transfusions are typically used.
- TXA may be considered in certain cases of upper GI bleeding, but its use should be cautious and as part of a comprehensive approach.
- The medication works by inhibiting fibrinolysis, which helps stabilize blood clots that form at bleeding sites.
- However, TXA is not considered first-line therapy for most GI bleeds and shows variable efficacy depending on the bleeding source and severity.
Evidence and Recommendations
Recent studies, such as the one published in the Journal of Hepatology 1, suggest that TXA should not be used in patients with cirrhosis and active variceal bleeding due to the lack of beneficial effect and potential increased risk of venous thromboembolic events.
- The study found that TXA did not reduce mortality or re-bleeding rates in patients with variceal bleeding and may even increase the risk of thromboembolic events.
- Another study published in Gut 1 also suggests that the use of TXA in acute lower GI bleeding should be confined to clinical trials, pending the results of the HALT-IT trial.
- It's crucial to weigh the potential benefits and risks of TXA in each individual case and consider alternative treatments, such as endoscopic interventions and blood product transfusions, as part of a comprehensive approach to managing GI bleeding.
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.