From the Guidelines
Tranexamic acid (TXA) should not be used as a first-line treatment for gastrointestinal (GI) bleeding outside of clinical trials, due to limited and uncertain evidence of its benefit in this setting. The role of TXA in treating GI bleeding is still being investigated, with some studies suggesting a potential benefit in reducing mortality, but these findings are not consistent across all trials 1. Specifically, a pooled analysis of trials on TXA in upper GI bleeding showed a 40% risk reduction in mortality, but this benefit was no longer apparent when only low-risk bias trials were considered 1.
The use of TXA in acute lower GI bleeding is currently recommended to be confined to clinical trials, pending the results of the HALT-IT trial 1. TXA works by inhibiting fibrinolysis, which can help stabilize formed blood clots, but its use also carries risks of thromboembolic complications, particularly in patients with pre-existing cardiovascular disease or hypercoagulable states.
Key points to consider when evaluating the use of TXA in GI bleeding include:
- Limited and uncertain evidence of benefit in GI bleeding
- Potential risks of thromboembolic complications
- Need for caution in patients with renal impairment or pre-existing cardiovascular disease
- Importance of standard treatments like endoscopic intervention, acid suppression therapy, and correction of coagulopathy in GI bleeding management.
From the Research
Role of Tranexamic Acid in Treating GI Bleeding
- Tranexamic acid (TXA) is a synthetic antifibrinolytic drug that has been studied for its effectiveness in treating gastrointestinal (GI) bleeding 2, 3, 4, 5, 6.
- The evidence suggests that TXA can aid in reducing the need for urgent endoscopy and may improve outcomes for patients with GI bleeding 2.
- A systematic review and meta-analysis found that TXA significantly reduced the rates of continued bleeding, urgent endoscopic intervention, and mortality compared to placebo 3.
- Another study found that extended-use high-dose IV TXA did not improve mortality or bleeding outcomes and increased adverse events, while low-dose IV/enteral TXA may be effective in reducing hemorrhage 4.
- A Cochrane review found that TXA appears to have a beneficial effect on mortality, but the evidence is not conclusive due to high dropout rates in some trials 5.
- A 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 6.
Efficacy of TXA in GI Bleeding
- TXA has been shown to reduce rebleeding rates in patients with GI bleeding, particularly in those with upper GI bleeding 3, 6.
- The evidence suggests that TXA may reduce mortality in patients with GI bleeding, but the results are not consistent across all studies 3, 5, 6.
- TXA has been found to reduce the need for surgical intervention in patients with GI bleeding, particularly in those with low risk of bias studies 6.
Safety of TXA in GI Bleeding
- The evidence suggests that TXA is generally safe and well-tolerated in patients with GI bleeding, but may increase the risk of thromboembolic events 4, 6.
- A systematic review and meta-analysis found that TXA was not associated with a significant increase in thrombotic events, but the evidence is not conclusive 6.
- TXA has been found to increase the risk of deep venous thrombosis, pulmonary embolism, and seizure in some studies 4.