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 patients with acute upper gastrointestinal bleeding, and even suggested an increased risk of venous thromboembolic events 1. The use of TXA in GI bleeding has been evaluated in several studies, but the most recent and relevant study, published in 2022, found that TXA did not reduce mortality or re-bleeding rates in patients with acute upper gastrointestinal bleeding, and actually increased the risk of venous thromboembolic events 1. Some key points to consider when managing GI bleeding include:
- The primary treatments for GI bleeding include endoscopic interventions, proton pump inhibitors (for upper GI bleeds), and addressing the underlying cause.
- TXA may have been considered as an adjunctive treatment in the past, but the latest evidence suggests that it should not be used due to the lack of benefit and potential harm.
- The management of GI bleeding should be tailored to the individual patient, taking into account the underlying cause of the bleeding, the severity of the bleeding, and the patient's overall health status. The study published in 2022 1 is the most relevant and highest quality study on this topic, and its findings should be prioritized when making decisions about the use of TXA in GI bleeding. In terms of specific patient populations, the study found that TXA was not beneficial in patients with suspected variceal bleeding and liver disease comorbidity, and may even have increased the risk of venous thromboembolic events in these patients 1. Overall, the evidence suggests that TXA should not be used to stop a GI bleed, and instead, other treatments such as endoscopic interventions and proton pump inhibitors should be prioritized.
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.