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 debated, and its use should be considered on a case-by-case basis. Some studies suggest that TXA may be beneficial in reducing rebleeding rates and mortality in certain cases of GI bleeding, particularly in upper GI bleeds 1. However, the most recent and highest quality study found that TXA had no beneficial effect in patients with acute upper gastrointestinal bleeding, including those with suspected variceal bleeding and liver disease comorbidity 1. In patients with hereditary hemorrhagic telangiectasia (HHT), TXA may be recommended for patients with mild GI bleeding due to its low potential for harm, but there is limited evidence of its effectiveness 1. Key considerations when using TXA include:
- Monitoring for potential side effects such as thrombotic events
- Using caution in patients with a history of thromboembolic disease or severe renal impairment
- Adjusting doses for renal dysfunction
- Considering the use of other standard treatments like proton pump inhibitors, endoscopic interventions, and blood product transfusions when necessary. It is essential to weigh the potential benefits and risks of TXA in each individual case and to consider the latest evidence and guidelines when making treatment decisions.
From the Research
Role of Tranexamic Acid in GI 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 upper GI bleeding, with some studies showing a significant reduction in mortality rates 3, 4, 5.
- However, other studies have found no significant difference in mortality rates between TXA and placebo or control groups 2, 6.
- In terms of bleeding outcomes, some studies have shown that TXA can reduce the risk of rebleeding and the need for surgery or transfusion 3, 5, while others have found no significant difference in bleeding outcomes between TXA and control groups 2, 6.
Adverse Events
- The use of TXA has been associated with an increased risk of adverse events, including deep venous thrombosis, pulmonary embolism, and seizure 2.
- Some studies have also reported an increased risk of venous thromboembolic events with TXA 6.
- However, other studies have found no significant difference in the risk of adverse events between TXA and control groups 3, 4, 5.
Dosage and Administration
- The optimal dosage and administration of TXA for GI bleeding are unclear, with studies investigating different dosing regimens and routes of administration 2, 3, 4, 5, 6.
- Some studies have suggested that low-dose or enteral TXA may be effective in reducing bleeding outcomes, while others have found no significant difference in outcomes between different dosing regimens 2, 3, 5.