From the Guidelines
Tranexamic acid (TXA) should not be used to stop and lower gastrointestinal (GI) bleeding, as the most recent and highest quality study suggests it has no beneficial effect and may even increase the risk of venous thromboembolic events 1.
Background
TXA is an antifibrinolytic agent that has been used to help control bleeding in various clinical settings. However, its effectiveness in GI bleeding is still a topic of debate.
Evidence
A large randomized placebo-controlled trial published in 2022 found that TXA had no beneficial effect in patients with acute upper gastrointestinal bleeding, including those with suspected variceal bleeding and liver disease comorbidity 1. In fact, the study found an almost 2-fold increase in the incidence of venous thromboembolic events in the TXA group compared to the placebo group.
Clinical Implications
Given the lack of evidence supporting the use of TXA in GI bleeding, and the potential risks associated with its use, it is recommended that TXA not be used as a treatment for GI bleeding. Instead, standard treatments such as endoscopic intervention, correction of coagulopathy, and addressing the underlying cause of bleeding should be prioritized.
Key Points
- TXA has no beneficial effect in GI bleeding and may increase the risk of venous thromboembolic events
- Standard treatments such as endoscopic intervention and correction of coagulopathy should be prioritized
- TXA is contraindicated in patients with active thromboembolic disease or severe renal impairment
- The use of TXA in GI bleeding should be avoided due to the lack of evidence supporting its effectiveness and the potential risks associated with its use 1.
From the Research
TXA and GI Bleed
- TXA (tranexamic acid) has been shown to be effective in reducing continued bleeding, urgent endoscopic intervention, and mortality in patients with upper gastrointestinal bleeding 2.
- However, the effects of TXA on lower gastrointestinal bleeding are not well established and require further clarification 2.
- The initial management of acute upper gastrointestinal bleeding includes fluid resuscitation, blood transfusions, respiratory support, and proton pump inhibitor therapy, but TXA is not typically mentioned as a standard treatment 3.
- Goals of care for gastrointestinal bleeding include stopping continued bleeding, supporting oxygen carrying capacity, and preventing rebleeding, but the use of TXA is not explicitly mentioned 4.
- Pharmacological treatment in upper gastrointestinal bleeding includes acid suppression therapy, vasoactive agents, and antibiotics, and recent evidence suggests that TXA may be useful in this context 5.
- Management of severe upper gastrointestinal bleeding in the ICU involves proton pump inhibitors, adequate resuscitation, and timely endoscopic intervention, but TXA is not typically mentioned as a standard treatment 6.