Can tranexamic acid (TXA) stop a gastrointestinal (GI) bleed?

From the Guidelines

Tranexamic acid (TXA) should not be used to stop a GI bleed, especially in cases of variceal bleeding, due to the lack of beneficial effect and potential increased risk of venous thromboembolic events. TXA works by inhibiting the breakdown of blood clots, which can reduce bleeding in some cases. However, for upper GI bleeding, the primary treatments typically include proton pump inhibitors (like pantoprazole 40mg IV twice daily), endoscopic interventions to directly treat the bleeding source, and correction of any coagulopathy 1. Some key points to consider when managing GI bleeding include:

• The use of TXA has been evaluated in several studies, but the most recent and highest quality study found no beneficial effect of TXA in stopping GI bleeding, and even suggested a potential harm due to increased risk of venous thromboembolic events 1.
• The primary goal in managing GI bleeding is to identify and address the underlying cause of bleeding, rather than relying solely on pharmacological treatments like TXA.
• A comprehensive treatment approach that includes endoscopic interventions, correction of coagulopathy, and supportive care is typically more effective in managing GI bleeding than TXA alone.
• In cases of variceal bleeding, the use of TXA is not recommended due to the lack of beneficial effect and potential increased risk of venous thromboembolic events 1. In summary, while TXA may have some benefits in certain scenarios, it is not recommended as a first-line treatment for GI bleeding, especially in cases of variceal bleeding, due to the lack of beneficial effect and potential increased risk of venous thromboembolic events.

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 varying results 2, 3, 4, 5, 6.
• A systematic review and meta-analysis published in 2021 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 meta-analysis published in 2020 found no significant difference in mortality, rebleeding, or need for surgery between TXA and placebo in patients with acute upper GI bleeding, but an increased risk of venous thromboembolic events with TXA 4.
• A comprehensive systematic review and meta-analysis published in 2025 found that TXA significantly reduced rebleeding rates and mortality in patients with acute GI bleeding, particularly in upper GI bleeding 5.
• A systematic review with meta-analysis published in 2020 found that TXA was superior to placebo for the reduction in mortality in patients with upper gastrointestinal bleeding, with moderate-quality evidence 6.

Safety and Adverse Events

• The use of TXA in GI bleeding has been associated with an increased risk of venous thromboembolic events 3, 4.
• However, a meta-analysis published in 2025 found no definitive evidence that TXA use is associated with thromboembolic events 5.
• The safety and efficacy of TXA in GI bleeding require cautious interpretation and individualized patient management 5.

Clinical Implications

• The available evidence suggests that TXA may be an effective medication for patients with upper GI bleeding, particularly when administered early 2, 5, 6.
• However, the effects of TXA on lower GI bleeding warrant further clarification 2, 5.
• Clinicians should carefully consider the potential benefits and risks of TXA in the management of GI bleeding, taking into account the individual patient's condition and medical history 3, 4, 5.