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 may vary depending on the cause and location of the bleed.
- For patients with hereditary hemorrhagic telangiectasia (HHT) and mild GI bleeding, TXA may be recommended due to its low potential for harm, although there is limited evidence of its effectiveness 1.
- In cases of acute lower GI bleeding, the use of TXA is not well established, and its benefit is uncertain 1.
- The decision to use TXA should be made on a case-by-case basis, taking into account the individual patient's risk factors and the underlying cause of the GI bleed.
- It's essential to note that TXA is not a replacement for standard treatments like endoscopic intervention, proton pump inhibitors, or blood products, but rather complements these approaches.
- Recent evidence from a large randomized controlled trial suggests that TXA may not be effective in reducing mortality in patients with acute upper gastrointestinal bleeding, including those with suspected variceal bleeding and liver disease comorbidity 1.
From the Research
Role of Tranexamic Acid in Treating Gastrointestinal Bleeding
- Tranexamic acid (TXA) has been proposed as a treatment for gastrointestinal (GI) bleeding, with studies investigating its efficacy in reducing mortality, bleeding, and adverse events 2, 3, 4, 5, 6.
- The evidence suggests that TXA may have a beneficial effect on mortality, particularly in patients with upper GI bleeding, with a reduction in the risk of death by 16% (OR=0.84,95% CI: 0.78 to 0.91, p<0.0001) 6.
- However, the results are not consistent across all studies, with some finding no significant difference in mortality or rebleeding rates between TXA and placebo 2, 5.
- TXA may increase the risk of venous thromboembolic events, with a pooled risk ratio of 1.94 (95% CI: 1.23-3.05) 5.
- The certainty of evidence for the different outcomes ranges from low to very low, highlighting the need for further high-quality research to fully understand the effects of TXA in GI bleeding 5.
Dosage and Administration
- The dosage and administration of TXA may impact its efficacy and safety, with high-dose IV TXA potentially increasing the risk of adverse events 2.
- Low-dose IV or enteral TXA may be effective in reducing rebleeding and the need for surgery, but more evidence is required to demonstrate its safety 2.
- Early administration of TXA, within 3 hours of bleeding onset, may be associated with a greater reduction in mortality (OR=0.80,95% CI: 0.73 to 0.88, p<0.0001) 6.
Clinical Implications
- The use of TXA in GI bleeding should be considered in the context of other relevant evidence, including its effects in other bleeding conditions 6.
- Clinicians should weigh the potential benefits and risks of TXA, including its impact on mortality, bleeding, and adverse events, when making treatment decisions 2, 3, 4, 5, 6.