From the Guidelines
Tranexamic acid (TXA) should not be used as a first-line therapy to stop GI bleeding, as its effectiveness is limited and it may increase the risk of thrombotic complications. The most recent and highest quality study, published in 2022 in the Journal of Hepatology 1, found that TXA did not have a beneficial effect in patients with acute upper gastrointestinal bleeding, and actually increased the risk of venous thromboembolic events. This study included 12,009 patients and had a strong recommendation against the use of TXA in patients with cirrhosis and active variceal bleeding.
When considering the use of TXA in GI bleeding, it is essential to weigh the potential benefits against the risks. While TXA may be effective in stabilizing clots and preventing further bleeding, its use is not supported by strong evidence and may be associated with significant side effects. The British Society of Gastroenterology guidelines, published in 2019, suggest that TXA may be considered in clinical trials, but its use is not recommended as a standard treatment for GI bleeding 1.
In specific scenarios, such as hereditary hemorrhagic telangiectasia, TXA may be recommended for patients with mild GI bleeding, but its effectiveness is still limited and it should be used with caution 1. The dose of TXA typically used is 1 gram intravenously every 6-8 hours, or 1-1.5 grams orally three times daily, but it should be reduced in patients with renal impairment.
Current practice favors other treatments, such as proton pump inhibitors, endoscopic interventions, and vasopressors, as primary management strategies for GI bleeding. These treatments have a stronger evidence base and are more effective in controlling bleeding and improving patient outcomes. TXA may be considered as an adjunctive therapy in specific scenarios, but it should not delay definitive interventions like endoscopy.
Key points to consider when using TXA in GI bleeding include:
- Limited effectiveness in stopping GI bleeding
- Increased risk of thrombotic complications
- Potential side effects, such as venous thromboembolic events
- Reduced dosing in patients with renal impairment
- Use as an adjunctive therapy in specific scenarios, but not as a first-line treatment.
From the Research
Role of Tranexamic Acid in Treating 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.
- However, a 2022 systematic review and meta-analysis found that 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 3.
- 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 4.
- A 2025 comprehensive systematic review and meta-analysis found that TXA significantly reduced rebleeding rates and mortality in patients with upper GI bleeding, but was linked to a significant increase in mortality in patients with lower GI bleeding 5.
- A 2020 systematic review with meta-analysis found that TXA was superior to placebo for the reduction in mortality in patients with upper gastrointestinal bleeding, with moderate-quality evidence 6.
Efficacy of Tranexamic Acid in GI Bleeding
- The efficacy of TXA in GI bleeding appears to depend on the dose and route of administration, as well as the location and severity of the bleeding 2, 3, 5.
- TXA may be more effective in reducing rebleeding and mortality in patients with upper GI bleeding, but its use in lower GI bleeding is less clear 2, 5.
- The quality of evidence for the use of TXA in GI bleeding is generally moderate to low, due to the risk of bias and heterogeneity among studies 2, 3, 4, 5, 6.