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 increased risk of venous thromboembolic events 1. When considering the use of TXA in GI bleeding, it's essential to weigh the potential benefits against the risks. While TXA has been shown to improve mortality in trauma patients and has some evidence for its benefit in acute GI bleeding 1, its effectiveness in stopping GI bleeds is not universally established.
Key Considerations
- 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.
- The use of TXA in GI bleeding may increase the risk of venous thromboembolic events, especially in patients with comorbid liver disease or suspected variceal bleeding 1.
- The primary management of GI bleeds should focus on identifying and treating the underlying cause, such as endoscopic intervention for bleeding ulcers or varices.
- TXA may be considered as an adjunctive therapy in specific cases, but its use should be cautious and monitored for potential side effects, including nausea, vomiting, diarrhea, and thromboembolic events.
Clinical Implications
- Clinicians should exercise caution when considering the use of TXA in patients with GI bleeding, particularly in those with cirrhosis or variceal bleeding.
- The decision to use TXA should be made on a case-by-case basis, taking into account the individual patient's risk factors and potential benefits.
- Further research is needed to fully understand the role of TXA in managing GI bleeding and to establish clear guidelines for its use.
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.