What is the role of tranexamic acid (TXA) in treating Gastrointestinal (GI) bleeding?

From the Guidelines

Tranexamic acid (TXA) should not be used to stop a GI bleed in patients with cirrhosis and active variceal bleeding, as it has been shown to have no beneficial effect and may increase the risk of venous thromboembolic events 1. In general, the role of TXA in treating GI bleeding is still being studied, and its effectiveness varies depending on the cause and location of the bleed. Some studies suggest that TXA may be beneficial in reducing mortality in upper GI bleeding, particularly when given early and in conjunction with other standard treatments such as proton pump inhibitors and endoscopic interventions 1. However, its effects are less established for lower GI bleeding, and more research is needed to determine its efficacy in this context. It's also important to note that TXA may have side effects, including nausea, vomiting, and a small increased risk of thromboembolism, so caution is advised in patients with a history of thromboembolic disease. In patients with hereditary hemorrhagic telangiectasia (HHT), TXA may be recommended for mild GI bleeding due to its low potential for harm, but its effectiveness is still limited by the available evidence 1. Ultimately, the decision to use TXA in GI bleeding should be made on a case-by-case basis, taking into account the individual patient's condition, the cause and severity of the bleed, and the potential risks and benefits of treatment. Key points to consider when using TXA for GI bleeding include:

• Administering TXA early, ideally within 3 hours of bleeding onset
• Using TXA in conjunction with other standard treatments, such as proton pump inhibitors and endoscopic interventions
• Monitoring patients for potential side effects, including nausea, vomiting, and thromboembolism
• Being cautious in patients with a history of thromboembolic disease
• Considering alternative treatments, such as systemic bevacizumab, for patients with moderate or severe GI bleeding 1.

From the Research

Role of Tranexamic Acid in Treating GI Bleeding

• Tranexamic acid (TXA) has been proposed as a treatment for gastrointestinal (GI) bleeding, with studies showing mixed results 2, 3, 4, 5, 6.
• A systematic review and meta-analysis of randomized controlled trials found that TXA significantly reduced the rates of continued bleeding, urgent endoscopic intervention, and mortality in patients with upper GI bleeding 2.
• Another study found that extended-use high-dose IV TXA did not reduce mortality or bleeding outcomes, but increased adverse events such as deep venous thrombosis, pulmonary embolism, and seizure 3.
• 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 in patients with upper GI bleeding 4.
• However, a systematic review and meta-analysis found that TXA did not improve outcomes in upper GI bleeding and may increase the risk of venous thromboembolic events 5.
• A comprehensive systematic review and meta-analysis found that TXA significantly reduced rebleeding rates, particularly in upper GI bleeding, and was associated with a mortality reduction when administered through both oral and intravenous routes 6.

Efficacy of TXA in GI Bleeding

• The efficacy of TXA in GI bleeding is still unclear, with studies showing mixed results 2, 3, 4, 5, 6.
• TXA may be effective in reducing hemorrhage in upper GI bleeding, but its effects on lower GI bleeding warrant further clarification 2.
• The optimal dose and route of TXA administration for GI bleeding are still unknown and require further study 4.
• TXA may be associated with an increased risk of thromboembolic events, particularly venous thromboembolic events 3, 5.

Safety of TXA in GI Bleeding

• The safety of TXA in GI bleeding is a concern, with studies showing an increased risk of adverse events such as deep venous thrombosis, pulmonary embolism, and seizure 3.
• TXA may be associated with an increased risk of thromboembolic events, particularly venous thromboembolic events 3, 5.
• However, a comprehensive systematic review and meta-analysis found that there was no definitive evidence that TXA use is associated with thromboembolic events 6.
• The safety of TXA in GI bleeding requires further study and cautious interpretation, particularly in individualized patient management 6.