From the Guidelines
Tranexamic acid (TXA) should not be used as a first-line therapy to stop GI bleeding, as the evidence for its effectiveness is mixed and less robust than for other hemostatic interventions. The primary treatments for GI bleeding remain endoscopic therapy, proton pump inhibitors (for upper GI bleeding), and correction of coagulopathy. TXA works as an antifibrinolytic agent by inhibiting plasminogen activation and preventing the breakdown of blood clots, potentially stabilizing clots that form at bleeding sites in the GI tract. However, a large randomised placebo-controlled trial including 12,009 patients with acute upper gastrointestinal bleeding found no beneficial effect of tranexamic acid in stopping GI bleeding, and even reported an increased incidence of venous thromboembolic events in the tranexamic acid group 1.
Some studies suggest that TXA may be considered as an adjunctive therapy in specific situations, particularly when endoscopic intervention is delayed or unavailable, or in cases of severe bleeding while awaiting definitive management, but the evidence is limited and the potential side effects, including thrombotic complications, should be carefully weighed against the potential benefits 1. Current guidelines generally do not strongly support routine use of TXA for GI bleeding outside of clinical trials or specific scenarios.
Key points to consider when evaluating the use of TXA in GI bleeding include:
- The lack of strong evidence supporting its effectiveness in stopping GI bleeding
- The potential for increased thrombotic complications
- The importance of prioritizing endoscopic therapy, proton pump inhibitors, and correction of coagulopathy as first-line treatments
- The need for careful consideration of the potential benefits and risks of TXA in specific clinical scenarios.
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 improving outcomes for patients with acute GI bleeding 2, 3.
- 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.
- However, another study found that extended-use high-dose IV TXA did not reduce mortality or bleeding outcomes and increased adverse events, such as deep venous thrombosis and pulmonary embolism 4.
- Low-dose IV/enteral TXA may be effective in reducing rebleeding and the need for surgery, but more evidence is required to demonstrate its safety 4.
- A meta-analysis of randomized controlled trials found that TXA with acid suppression significantly reduced the risk of rebleeding, units of blood transfused, and the need for salvage therapy compared to acid suppression alone 5.
- However, another study found that TXA did not improve outcomes in upper GI bleeding and may increase the risk of venous thromboembolic events 6.
Key Findings
- TXA can reduce the need for urgent endoscopy and improve outcomes for patients with acute GI bleeding 2, 3.
- TXA may be effective in reducing rebleeding and the need for surgery, but more evidence is required to demonstrate its safety 4, 5.
- The use of TXA in GI bleeding is still controversial, and more studies are needed to determine its efficacy and safety 3, 4, 5, 6.
TXA Administration
- The optimal dose and route of TXA administration for GI bleeding are still unclear and require further study 3, 4, 5.
- High-dose IV TXA may increase the risk of adverse events, such as deep venous thrombosis and pulmonary embolism 4.
- Low-dose IV/enteral TXA may be a safer and more effective option for reducing rebleeding and the need for surgery 4, 5.