From the Guidelines
Tranexamic acid (TXA) should not be routinely used in the management of lower gastrointestinal bleeding, except in clinical trials, due to limited evidence supporting its benefit in this context. The use of TXA in lower GI bleeding is not well established, and its role is primarily based on its efficacy in trauma and upper GI bleeding 1. In the management of lower GI bleeding, the focus should be on hemodynamic stabilization, blood product replacement as needed, endoscopic evaluation and intervention, radiologic interventions, or surgery when appropriate.
The evidence for TXA use in lower GI bleeding is limited, and most studies have been conducted in the context of upper GI bleeding or trauma 1. The British Society of Gastroenterology guidelines suggest that TXA may be considered in clinical trials for acute lower GI bleeding, but its use is not recommended as standard therapy 1.
When considering the use of TXA in lower GI bleeding, it is essential to weigh the potential benefits against the risks, including an increased risk of thrombotic events, particularly in patients with pre-existing cardiovascular disease or hypercoagulable states 1. The dose and duration of TXA administration may vary, but typically, it is administered at a dose of 1 gram intravenously every 6-8 hours until bleeding is controlled, generally not exceeding 3-4 grams per day.
Key considerations in the management of lower GI bleeding include:
- Hemodynamic stabilization
- Blood product replacement as needed
- Endoscopic evaluation and intervention
- Radiologic interventions
- Surgery when appropriate
- Individual risk-benefit assessment for TXA use, if considered.
In summary, while TXA may have a role in certain cases of lower GI bleeding, its use should be approached with caution, and standard management strategies should be prioritized.
From the Research
Role of Tranexamic Acid in Lower GI Bleed Management
- The use of tranexamic acid (TXA) in the management of lower gastrointestinal (GI) bleed is still unclear, with limited and heterogeneous evidence 2.
- A study published in 2018 found that TXA did not decrease blood loss or improve clinical outcomes in patients presenting with lower GI hemorrhage 3.
- 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, but more evidence is required to demonstrate its safety 4.
- A 2024 systematic review and meta-analysis found that TXA does not reduce mortality in patients with acute upper or lower gastrointestinal bleeding and may confer an increased risk of seizures 5.
- Another study published in 2025 found that TXA was linked to a significant increase in mortality in patients with lower GI bleeding (RR: 1.67,95% CI: 1.44-1.93) 6.
Key Findings
- TXA may not be effective in reducing blood loss or improving clinical outcomes in patients with lower GI bleed 3, 5.
- The use of TXA in lower GI bleed management may be associated with an increased risk of adverse events, such as seizures 4, 5.
- More evidence is required to determine the safety and efficacy of TXA in the management of lower GI bleed 4, 6.
Clinical Implications
- The current evidence does not support the routine use of TXA in the management of lower GI bleed 3, 5.
- Clinicians should exercise caution when considering the use of TXA in patients with lower GI bleed, due to the potential risks of adverse events 4, 5.
- Further studies are needed to determine the optimal management strategy for lower GI bleed, including the potential role of TXA 2, 6.