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 debated, and its use should be considered on a case-by-case basis. Some studies suggest that TXA may be beneficial in certain scenarios, such as in patients with hereditary hemorrhagic telangiectasia (HHT) and mild GI bleeding, where it is recommended due to its low potential for harm, despite limited evidence of effectiveness 1. However, in other cases, such as in patients with acute lower gastrointestinal bleeding, the use of TXA is not recommended outside of clinical trials, pending further evidence 1. It's essential to weigh the potential benefits and risks of TXA in each individual case, considering factors such as the underlying cause of the bleeding, the patient's medical history, and the potential for thrombotic complications. In patients with cirrhosis and active bleeding related to portal hypertension, but not to varices, the use of TXA is not recommended, and correction of coagulopathy should be considered on a case-by-case basis 1. Ultimately, the decision to use TXA in GI bleeding should be made in consultation with a healthcare professional and based on the most up-to-date evidence and guidelines. Key points to consider when using TXA in GI bleeding include:

• Potential benefits: reduction of mortality and bleeding in certain scenarios
• Potential risks: thrombotic complications, increased risk of venous thromboembolic events
• Recommended dosing: typically 1 gram administered intravenously over 10 minutes, followed by 1 gram over 8 hours, though practices may vary
• Importance of individualized decision-making, considering the underlying cause of the bleeding and the patient's medical history.

From the Research

Role of Tranexamic Acid in Treating GI Bleeding

• Tranexamic acid (TXA) is a synthetic antifibrinolytic drug that has been studied for its effectiveness in treating gastrointestinal (GI) bleeding 2, 3, 4, 5, 6.
• The evidence suggests that TXA may be effective in reducing the risk of continued bleeding, urgent endoscopic intervention, and mortality in patients with upper GI bleeding 4, 5.
• However, the results are not consistent across all studies, and some have found no significant difference in outcomes between TXA and placebo or usual care 3, 6.
• The use of high-dose IV TXA has been associated with an increased risk of thromboembolic events, including deep venous thrombosis and pulmonary embolism 3, 6.

Efficacy of TXA in GI Bleeding

• A systematic review and meta-analysis found that TXA significantly reduced the rates of continued bleeding, urgent endoscopic intervention, and mortality in patients with upper GI bleeding 4.
• Another study found that TXA did not reduce mortality or bleeding outcomes, but may be effective in reducing the need for urgent endoscopy 2.
• A meta-analysis of randomized controlled trials found that TXA did not improve outcomes in acute upper GI bleeding and may increase the risk of venous thromboembolic events 6.

Safety of TXA in GI Bleeding

• The safety of TXA in patients with GI bleeding has been evaluated in several studies, with some finding no significant increase in adverse events 2, 5.
• However, other studies have found an increased risk of thromboembolic events, including deep venous thrombosis and pulmonary embolism, with the use of high-dose IV TXA 3, 6.
• The certainty of evidence for the safety of TXA in GI bleeding is generally considered low to very low due to the limited number of studies and the variability in results 6.