From the Guidelines
Tranexamic acid (TXA) should not be used as a standard treatment for gastrointestinal (GI) bleeding outside of clinical trials, due to limited evidence of its effectiveness and potential risks of thromboembolic events. The use of TXA in GI bleeding is still being studied, and its benefits and risks are not yet fully understood 1.
Current Evidence
- A 2019 study published in the journal Gut found that TXA improved mortality from trauma when given intravenously in the acute setting, but its benefit in acute GI bleeding was uncertain 1.
- The same study noted that several trials of TXA in upper GI bleeding (UGIB) showed a 40% risk reduction in mortality, but this benefit was no longer apparent when the analysis was limited to trials at low risk of bias 1.
- A 2021 study published in the journal Blood recommended TXA for patients with mild GI bleeding due to its low potential for harm, but noted that there was limited evidence of its effectiveness 1.
Clinical Considerations
- TXA works by inhibiting plasminogen activation, which prevents the breakdown of blood clots and helps maintain clot stability 1.
- However, TXA should be used with caution in patients with a history of thromboembolic events, as it may increase the risk of clot formation 1.
- The evidence for TXA in GI bleeding is limited, and its use should be confined to clinical trials pending the results of further studies, such as the HALT-IT trial 1.
Treatment Approach
- For patients with GI bleeding, standard treatments like proton pump inhibitors, endoscopic therapy, and blood product transfusions should be used as first-line treatments.
- TXA may be considered as an adjunct to these standard treatments in certain cases, but its use should be carefully weighed against its potential risks and benefits.
From the Research
TXA Treatment for GI Bleed
- The effectiveness of tranexamic acid (TXA) in treating gastrointestinal (GI) bleeding is a topic of ongoing research and debate 2, 3, 4, 5, 6.
- A systematic review and meta-analysis published in 2025 found that TXA significantly reduced rebleeding rates overall (RR: 0.81,95% CI: 0.87-0.97) and 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) 2.
- However, another study published in 2024 found that TXA did not reduce mortality in patients with acute upper or lower gastrointestinal bleeding and may confer an increased risk of seizures (RR: 1.73,95% CI: 1.03-2.93) 4.
- A meta-analysis published in 2021 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 in patients with upper gastrointestinal bleeding 5.
- A systematic review and meta-analysis published in 2022 found that extended-use high-dose IV tranexamic acid did not reduce mortality or bleeding outcomes and increased adverse events, while low-dose IV/enteral tranexamic acid may be effective in reducing hemorrhage but requires more evidence to demonstrate its safety 6.
Key Findings
- TXA may be effective in reducing rebleeding rates and mortality in certain subgroups of patients with GI bleeding 2, 5.
- However, the evidence is not consistent, and some studies have found no benefit or even increased risk of adverse events with TXA use 4, 6.
- The optimal dosing strategy and patient population for TXA use in GI bleeding remain unclear and require further research 2, 6.