From the Guidelines
Tranexamic acid (TXA) should not be used as a first-line treatment for gastrointestinal (GI) bleeding, and its use is generally not recommended due to limited evidence of effectiveness and potential risks of thromboembolic events. The most recent and highest quality study, published in 2022 in the Journal of Hepatology 1, found no beneficial effect of TXA in patients with acute upper gastrointestinal bleeding, including those with suspected variceal bleeding and liver disease comorbidity. In fact, the study reported an almost 2-fold increase in the incidence of venous thromboembolic events in the TXA group compared to the placebo group.
Key points to consider when evaluating the use of TXA in GI bleeding include:
- Limited evidence of effectiveness in reducing mortality or improving outcomes in GI bleeding
- Potential risks of thromboembolic events, particularly in patients with comorbid liver disease or suspected variceal bleeding
- Standard first-line treatments for GI bleeding, such as proton pump inhibitors, endoscopic interventions, and correction of coagulopathies, remain the preferred approach
- TXA may be considered as an adjunctive treatment in specific cases where standard therapies have failed or are unavailable, but its use should be cautious and carefully weighed against potential risks.
It's also important to note that other studies, such as the one published in 2021 in Blood 1, recommend TXA for patients with mild GI bleeding, but the evidence is limited and the potential for harm should be carefully considered. Additionally, the study published in 2019 in Gut 1 suggests that TXA may have a beneficial effect in acute GI bleeding, but the evidence is mixed and the study has limitations. Overall, the most recent and highest quality study 1 provides the strongest evidence for not using TXA as a first-line treatment for GI bleeding.
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.