From the Guidelines
Tranexamic acid (TXA) can be used to help stop gastrointestinal (GI) bleeding, particularly in patients with mild GI bleeding, as it has a low potential for harm, although the evidence of its effectiveness is limited. According to the guidelines for hereditary hemorrhagic telangiectasia, TXA is recommended for patients with mild GI bleeding 1. The medication works by inhibiting the breakdown of blood clots, which helps control bleeding.
For acute GI bleeding, the use of TXA is still being studied, and its benefits are not as clear-cut. Some studies suggest that TXA may improve mortality in acute GI bleeding, but these findings are based on older trials and may not be applicable to modern-day care 1. The British Society of Gastroenterology guidelines suggest that the use of TXA in acute lower gastrointestinal bleeding should be confined to clinical trials, pending the results of further studies 1.
In terms of administration, TXA is typically given intravenously, but the optimal dose and duration of treatment are not well established for GI bleeding. The dose and administration protocol may vary depending on the specific clinical context and the patient's underlying condition. It's essential to weigh the potential benefits of TXA against the risks, particularly in patients with a history of thromboembolic events, as TXA may increase the risk of clot formation elsewhere in the body.
Key points to consider when using TXA for GI bleeding include:
- TXA is recommended for patients with mild GI bleeding due to its low potential for harm 1
- The evidence for TXA's effectiveness in acute GI bleeding is limited and inconclusive 1
- TXA should be used cautiously in patients with a history of thromboembolic events
- The optimal dose and administration protocol for TXA in GI bleeding are not well established and may vary depending on the clinical context.
From the Research
Efficacy of TXA in Stopping GI Bleeding
- TXA has been shown to reduce the need for urgent endoscopy in patients with acute gastrointestinal bleeding 2
- A meta-analysis of 23 studies demonstrated that TXA significantly reduced rebleeding rates overall (RR: 0.81,95% CI: 0.87-0.97) 3
- TXA may reduce all-cause mortality in patients with upper gastrointestinal bleeding (RR: 0.61,95% CI: 0.42-0.89) 4
- A systematic review and meta-analysis of individual patient data from 64,724 bleeding patients found that TXA reduced the odds of death by 16% (OR=0.84,95% CI: 0.78 to 0.91, p<0.0001) 5
- Another meta-analysis of 13 randomized controlled trials found that TXA significantly reduced the rates of continued bleeding (RR = 0.60; 95%CI, 0.43-0.84), urgent endoscopic intervention (RR = 0.35; 95%CI, 0.24-0.50), and mortality (RR = 0.60; 95%CI, 0.45-0.80) compared with the placebo 6
Safety and Potential Side Effects
- No significant statistical differences were seen between treatment groups regarding mortality, re-bleeding, blood transfusion, and endoscopic and/or surgical intervention rates in one study 2
- TXA was linked to a significant increase in mortality in patients with lower GI bleeding (RR: 1.67,95% CI: 1.44-1.93) in another study 3
- There was no definitive evidence that TXA use is associated with thromboembolic events in several studies 3, 4, 5
- Adverse events were unclearly reported in some studies 4
Subgroup Analysis
- TXA use was associated with a mortality reduction when administered through both oral and intravenous routes (RR: 0.56,95% CI: 0.35-0.89) and in cases of upper GI bleeding (RR: 0.72,95% CI: 0.59-0.87) 3
- The need for surgical interventions was significantly reduced when considering only low risk of bias studies (RR: 0.85,95% CI: 0.75 to 0.97, I2=0%) 3
- TXA reduced the odds of death by 20% (0.80,0.73 to 0.88, p<0.0001) in patients treated within 3 hours of bleeding onset 5