From the Guidelines
Tranexamic acid (TXA) should not be used as a primary treatment for GI bleeding outside of clinical trials, due to limited evidence of its effectiveness and potential risks of thromboembolic events. For patients with mild GI bleeding, TXA may be considered as an adjunctive therapy, but its use should be approached with caution and careful consideration of the potential benefits and risks 1. The most recent and highest quality study available is from 2019, which suggests that the use of TXA in acute lower gastrointestinal bleeding (LGIB) should be confined to clinical trials, pending the results of the HALT-IT trial 1.
Key Considerations
- TXA works by inhibiting fibrinolysis, which can help stabilize clots that form at bleeding sites
- The evidence for TXA's effectiveness in GI bleeding is limited, and its use is not recommended as a primary treatment outside of clinical trials
- Patients with a history of thromboembolism should be approached with caution when considering TXA therapy
- Other treatment options, such as proton pump inhibitors, endoscopic intervention, and correction of coagulopathy, should be considered as first-line treatments for GI bleeds
Additional Evidence
A 2021 study published in the journal Blood recommends TXA for patients with mild GI bleeding due to hereditary hemorrhagic telangiectasia (HHT), but notes that there is limited evidence of its effectiveness 1. However, this study is not directly applicable to the general population with GI bleeding, and its findings should be interpreted with caution. Overall, the use of TXA in GI bleeding should be approached with caution and careful consideration of the potential benefits and risks, and its use should be guided by the most recent and highest quality evidence available 1.
From the Research
TXA Treatment for GI Bleed
- The use of tranexamic acid (TXA) in treating gastrointestinal (GI) bleeding has been studied in various trials, with mixed results 2, 3, 4, 5, 6.
- A systematic review and meta-analysis found that TXA significantly reduced rebleeding rates overall, particularly in upper GI bleeding, and was associated with a mortality reduction when administered through both oral and intravenous routes 2.
- However, another study found that TXA did not reduce mortality in patients with acute upper or lower GI bleeding and may confer an increased risk of seizures 4.
- A meta-analysis of randomized controlled trials revealed that TXA significantly reduced the rates of continued bleeding, urgent endoscopic intervention, and mortality compared with the placebo in patients with upper GI bleeding 5.
- Extended-use high-dose IV TXA did not reduce mortality or bleeding outcomes and increased adverse events, while low-dose IV/enteral TXA may be effective in reducing hemorrhage but requires more evidence to demonstrate its safety 6.
Efficacy of TXA in GI Bleed
- The efficacy of TXA in treating GI bleed varies depending on the dosage, administration route, and type of GI bleeding 2, 4, 5, 6.
- TXA has been shown to be effective in reducing rebleeding rates and mortality in upper GI bleeding, but its effectiveness in lower GI bleeding is less clear 2, 5.
- The use of TXA in GI bleeding requires cautious interpretation and individualized patient management due to the potential risks of thromboembolic events and seizures 2, 4, 6.
Safety of TXA in GI Bleed
- The safety of TXA in treating GI bleed has been a concern due to the potential risks of thromboembolic events and seizures 2, 4, 6.
- A study found that TXA was linked to a significant increase in mortality in patients with lower GI bleeding 2.
- Another study found that extended-use high-dose IV TXA resulted in a small increase in deep venous thrombosis, pulmonary embolism, and seizure 6.
- However, a meta-analysis found that TXA did not increase the risk of venous thromboembolism in patients with GI bleeding 5.