From the Guidelines
Tranexamic acid (TXA) is not recommended as a first-line treatment for lower gastrointestinal bleeding. The primary management of lower GI bleeding should focus on resuscitation, hemodynamic stabilization, and endoscopic evaluation to identify and treat the bleeding source. While TXA is an antifibrinolytic agent that helps maintain blood clots by inhibiting plasmin-mediated fibrin degradation, evidence for its effectiveness specifically in lower GI bleeding is limited and inconsistent, as noted in the guidelines from the British Society of Gastroenterology 1.
For acute lower GI bleeding, initial management typically includes:
- Fluid resuscitation
- Blood product transfusion if needed
- Correction of coagulopathy
- Prompt endoscopic evaluation If endoscopic therapy is required, options include:
- Thermal coagulation
- Injection therapy
- Mechanical methods like clips depending on the bleeding source TXA may have a role in certain bleeding scenarios, particularly upper GI bleeding, but it should not replace established first-line interventions for lower GI bleeding. The risk-benefit profile of TXA in lower GI bleeding remains unclear, with potential concerns about thrombotic complications, particularly in patients with cardiovascular disease or other prothrombotic conditions.
In the context of hereditary hemorrhagic telangiectasia, TXA is recommended for patients with mild GI bleeding due to its low potential for harm, although evidence of its effectiveness is limited 1. However, for the general management of lower GI bleeding, the focus should remain on established interventions rather than TXA, given the current state of evidence. The use of TXA in trauma patients has shown benefits in reducing mortality due to bleeding 1, but this does not directly translate to its use in lower GI bleeding without specific, high-quality evidence supporting its effectiveness in this context.
From the Research
Effectiveness of Tranexamic Acid in Lower GI Bleeding
- The use of tranexamic acid (TXA) in lower gastrointestinal (GI) bleeding is still a topic of debate, with varying results from different studies 2, 3, 4, 5, 6.
- A study published in 2018 found that TXA did not decrease blood loss or improve clinical outcomes in patients with lower GI hemorrhage 5.
- Another study published in 2020 found that TXA did not reduce death from gastrointestinal bleeding, including lower GI bleeding 3.
- A 2022 systematic review and meta-analysis found that extended-use high-dose IV TXA did not improve mortality or bleeding outcomes in patients with gastrointestinal bleeding, including lower GI bleeding, and increased adverse events 4.
- However, a 2025 systematic review and meta-analysis found that TXA was associated with 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 bleeding 5.
- The use of TXA in lower GI bleeding may be associated with an increased risk of mortality 6.
- More research is needed to fully understand the effects of TXA in lower GI bleeding 2, 3, 4, 5, 6.