From the Guidelines
Tranexamic acid (TXA) is not currently recommended as a first-line treatment for lower gastrointestinal (G.I.) bleeding. The most recent and highest quality study, published in 2019 in the journal Gut 1, suggests that the use of TXA in acute lower G.I. bleeding should be confined to clinical trials, pending the results of the HALT-IT trial. This guideline is based on the limited and inconsistent evidence for the routine use of TXA in lower G.I. bleeding, as well as concerns about potential adverse effects, including thrombotic complications.
Some key points to consider when managing lower G.I. bleeding include:
- Hemodynamic stabilization with intravenous fluids or blood products as needed
- Diagnostic procedures such as colonoscopy to identify and potentially treat the bleeding source
- Targeted interventions based on the specific cause of the bleeding While TXA has established benefits in trauma-related bleeding and upper G.I. hemorrhage, its use in lower G.I. bleeding is not supported by strong evidence, and therefore, it should not be used as a first-line treatment. The focus should be on resuscitation, identifying the bleeding source, and providing targeted interventions based on the specific cause, rather than empiric TXA administration, as suggested by the British Society of Gastroenterology guidelines 1.
From the Research
Tranexamic Acid for Lower G.I. Bleeding
- The use of tranexamic acid (TXA) for lower gastrointestinal (G.I.) bleeding is a topic of ongoing research and debate 2, 3, 4, 5.
- A systematic review and meta-analysis published in 2025 found that TXA was associated with a significant increase in mortality in patients with lower G.I. bleeding (RR: 1.67,95% CI: 1.44-1.93) 3.
- Another study published in 2022 found that extended-use high-dose IV TXA did not reduce mortality or bleeding outcomes and increased adverse events, including deep venous thrombosis, pulmonary embolism, and seizure 4.
- A 2021 systematic review with meta-analysis of randomized clinical trials found that TXA significantly reduced the rates of continued bleeding, urgent endoscopic intervention, and mortality in patients with upper gastrointestinal bleeding, but the effects of TXA on lower gastrointestinal bleeding were not clear 5.
- The clinical use of TXA is not without controversy, and its administration needs to be standardized to minimize adverse effects, such as seizures and other adverse events 6.
Key Findings
- TXA may not be effective in reducing mortality or bleeding outcomes in patients with lower G.I. bleeding 3, 4.
- The use of TXA in lower G.I. bleeding may be associated with an increased risk of adverse events, such as deep venous thrombosis, pulmonary embolism, and seizure 4.
- Further research is needed to determine the efficacy and safety of TXA in patients with lower G.I. bleeding 3, 4, 5.