From the Guidelines
Tranexamic acid (TXA) should not be used to stop a GI bleed, as the most recent and highest quality study found no beneficial effect of TXA in acute upper gastrointestinal bleeding, and even an increased risk of venous thromboembolic events 1.
GI Bleeding Management
The management of GI bleeding involves a comprehensive approach, including endoscopic intervention, proton pump inhibitors (for upper GI bleeds), and correction of coagulopathy. TXA is not typically considered first-line therapy for GI bleeds, and its use should be weighed against the potential risks, such as thrombotic complications.
TXA Mechanism and Effectiveness
TXA works by inhibiting plasminogen activation, which prevents the breakdown of fibrin clots that form at bleeding sites. However, the effectiveness of TXA varies depending on the cause and location of the bleeding, and it may not be effective in all cases of GI bleeding.
Recent Study Findings
A large randomized placebo-controlled trial found no beneficial effect of TXA in acute upper gastrointestinal bleeding, and even an increased risk of venous thromboembolic events 1. This study suggests that TXA should not be used as a treatment for GI bleeding, and that other management strategies should be prioritized.
Clinical Implications
In clinical practice, the management of GI bleeding should focus on standard treatments, such as endoscopic intervention and correction of coagulopathy, rather than the use of TXA. The potential benefits and risks of TXA should be carefully considered, and it should only be used in specific situations where the benefits outweigh the risks.
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.