From the Guidelines
Tranexamic acid (TXA) should not be used as a standard treatment for acute lower gastrointestinal bleeding outside of clinical trials, due to limited evidence supporting its benefit in this specific context. The use of TXA in lower GI bleeding is not well established, and current guidelines suggest that its use be confined to clinical trials, pending the results of further studies such as the HALT-IT trial 1. While TXA has been shown to be effective in reducing mortality in trauma patients with bleeding 1, its role in managing lower GI bleeding is less clear. The majority of evidence for TXA is based on its use in upper GI bleeding and trauma, with limited studies specifically addressing its use in lower GI bleeding.
Some studies have proposed clinical prognostic criteria to distinguish patients with a high and a low risk of recurrent hemorrhage, such as the BLEED classification system 1. However, these criteria are not directly related to the use of TXA in lower GI bleeding. Other studies have investigated the use of artificial neural networks (ANN) in predicting clinical outcome in patients with acute lower gastrointestinal bleeding, but these findings are not relevant to the use of TXA in this context 1.
In general, the management of lower GI bleeding involves a combination of supportive care, endoscopic interventions, and surgical therapy, with the goal of achieving hemostasis and preventing recurrent bleeding 1. While TXA may be considered as an adjunctive therapy in certain cases, its use should be approached with caution and ideally as part of a clinical trial, given the limited evidence supporting its benefit in lower GI bleeding.
Key considerations in the management of lower GI bleeding include:
- Early recognition and diagnosis of bleeding
- Prompt initiation of supportive care, including fluid resuscitation and blood product transfusion
- Endoscopic evaluation and intervention, as needed
- Surgical therapy, in cases where endoscopic management is unsuccessful or not possible
- Consideration of clinical prognostic criteria, such as the BLEED classification system, to guide management decisions.
Overall, while TXA may have a potential role in managing lower GI bleeding, its use should be approached with caution and ideally as part of a clinical trial, given the limited evidence supporting its benefit in this specific context.
From the Research
Lower GI Bleeding and Tranexamic Acid
- The role of tranexamic acid (TXA) in managing lower gastrointestinal (GI) bleeding is not well-established, with limited and heterogeneous evidence available 2, 3.
- A narrative review found that TXA was not effective in reducing bleeding in lower gastrointestinal bleeding 3.
- A systematic review and meta-analysis found that extended-use high-dose IV tranexamic acid did not reduce mortality or bleeding outcomes in gastrointestinal bleeding, but low-dose IV/enteral tranexamic acid may be effective in reducing hemorrhage, although more evidence is required to demonstrate its safety 4.
- Another systematic review and meta-analysis found that tranexamic acid significantly reduced the rates of continued bleeding, urgent endoscopic intervention, and mortality in upper gastrointestinal bleeding, but the effects of tranexamic acid on lower gastrointestinal bleeding warrant further clarification 2.
Key Findings
- TXA may not be effective in reducing bleeding in lower GI bleeding 3.
- Low-dose IV/enteral tranexamic acid may be effective in reducing hemorrhage, but more evidence is required to demonstrate its safety 4.
- The effects of tranexamic acid on lower gastrointestinal bleeding are not well-established and require further clarification 2.
Adverse Events
- The use of TXA has been associated with an increased risk of thrombotic events, such as deep venous thrombosis, pulmonary embolism, and cerebral infarction 4, 5.
- However, a systematic review and meta-analysis found that intravenous TXA was not associated with an increased risk of thromboembolic events or mortality 5.