From the Guidelines
Tranexamic acid (TXA) is not recommended for the treatment of lower gastrointestinal (GI) bleeding due to the lack of clear mortality benefits and concerns about potential thromboembolic complications. The most recent and highest quality study, 1, suggests that the use of TXA in acute lower GI bleeding is not supported by current evidence and should be confined to clinical trials.
Key Points to Consider
- Current evidence does not support the use of TXA in lower GI bleeding, unlike its established role in upper GI bleeds 1.
- The recommended treatment approach for lower GI bleeds includes initial resuscitation, blood transfusions if necessary, and prompt diagnostic evaluation with colonoscopy once the patient is stabilized.
- Specific interventions depend on the identified cause, with options including endoscopic therapy, interventional radiology procedures, or surgery for uncontrollable hemorrhage.
- The pathophysiology and accessibility of lower GI bleeding sources differ from upper GI bleeds, making local hemostatic approaches through endoscopy or interventional procedures more effective than systemic antifibrinolytic therapy.
Additional Considerations
- Studies have not demonstrated clear mortality benefits in lower GI bleeding, and there are concerns about potential thromboembolic complications 1.
- The use of TXA in patients with cirrhosis and active variceal bleeding is not recommended due to the lack of beneficial effect and potential increased risk of venous thromboembolic events 1.
- A restrictive red blood cell transfusion strategy is beneficial in patients with cirrhosis and active bleeding, and administration of large volumes of blood products may paradoxically increase bleeding rather than contribute to control of bleeding 1.
From the Research
Lower GI Bleed Treatment
The use of tranexamic acid (TXA) in treating lower gastrointestinal (GI) bleeding is not well-established.
- Current research focuses primarily on upper GI bleeding, with studies such as 2 and 3 investigating the effects of TXA in this context.
- While 2 suggests that TXA may be effective in reducing continued bleeding and mortality in upper GI bleeding, its effects on lower GI bleeding are not clearly defined.
- A study by 4 found that 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 and efficacy in lower GI bleeding.
TXA Efficacy and Safety
The efficacy and safety of TXA in GI bleeding are still being researched, with mixed results:
- 5 found that TXA reduced the odds of death by 16% in patients with bleeding, including those with GI bleeding.
- However, 4 reported that extended-use high-dose IV TXA did not reduce mortality or bleeding outcomes and increased adverse events.
- 6 discusses the medical management of non-variceal upper GI bleeding, highlighting the importance of endoscopy and pharmacological therapies, but does not provide specific guidance on TXA use in lower GI bleeding.
Future Research Directions
Further studies are needed to determine the effectiveness and safety of TXA in treating lower GI bleeding:
- Research should focus on conducting randomized controlled trials to assess the efficacy of TXA in lower GI bleeding.
- Studies should also investigate the optimal dosing and administration of TXA in this context.
- The results of such studies will help clarify the role of TXA in managing lower GI bleeding.