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. The use of TXA in GI bleeding is still a topic of debate, and its effectiveness varies depending on the underlying cause of the bleed. In patients with hereditary hemorrhagic telangiectasia, TXA may be recommended for mild GI bleeding due to its low potential for harm, although there is limited evidence of its effectiveness 1. However, in patients with cirrhosis and active variceal bleeding, the use of TXA is not recommended due to the lack of beneficial effect and potential increased risk of thromboembolic events 1. In general, the management of GI bleeding should be tailored to the individual patient and the underlying cause of the bleed, and should involve a comprehensive approach including endoscopic interventions, proton pump inhibitors, and blood product transfusions as needed.

Some key points to consider when using TXA in GI bleeding include:

• The recommended dosing and administration of TXA, which typically involves an initial dose of 1 gram administered intravenously over 10 minutes, followed by additional doses or a continuous infusion as needed.
• The potential benefits and risks of TXA, including its ability to inhibit fibrinolysis and stabilize blood clots, as well as its potential to increase the risk of thromboembolic events in certain patient populations.
• The importance of individualizing treatment and considering the underlying cause of the GI bleed, as well as the patient's overall clinical condition and medical history.
• The need for careful monitoring and follow-up to assess the effectiveness of TXA and adjust treatment as needed.

It's also important to note that the use of TXA in GI bleeding has been evaluated in several studies, including a large randomized controlled trial that found no beneficial effect of TXA in patients with acute upper gastrointestinal bleeding, including those with suspected variceal bleeding and liver disease comorbidity 1. Another study found that TXA may be beneficial in patients with mild GI bleeding due to hereditary hemorrhagic telangiectasia, although the evidence is limited 1. Overall, the use of TXA in GI bleeding should be approached with caution and careful consideration of the individual patient's needs and circumstances.

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 can aid in reducing the need for urgent endoscopy and may decrease the rate of re-bleeding in patients with GI bleeding 2, 4, 5.
• A systematic review and meta-analysis found that TXA significantly reduced the rates of continued bleeding, urgent endoscopic intervention, and mortality compared to placebo in patients with upper GI bleeding 4.
• Another study found that extended-use high-dose IV TXA did not reduce mortality or bleeding outcomes, but low-dose IV/enteral TXA may be effective in reducing hemorrhage 3.
• TXA has also been shown to be beneficial as adjunctive therapy in treating major upper GI bleeding in dialysis patients, reducing the rate of early re-bleeding and the need for repeated endoscopic procedures 5.

Efficacy of TXA in GI Bleeding

• The efficacy of TXA in GI bleeding is supported by several studies, including a randomized controlled trial that found TXA reduced the need for urgent endoscopy and improved outcomes for patients with acute GI bleeding 2.
• A systematic review found that TXA appears to have a beneficial effect on mortality, but the evidence is not yet conclusive due to high dropout rates in some trials 6.
• The optimal dosing and administration of TXA for GI bleeding is still unclear, with some studies suggesting that low-dose IV/enteral TXA may be more effective than high-dose IV TXA 3, 4.

Safety and Adverse Events

• The safety profile of TXA in GI bleeding is generally favorable, with few reported adverse events 2, 3, 4.
• However, one study found that extended-use high-dose IV TXA increased the risk of deep venous thrombosis, pulmonary embolism, and seizure 3.
• Further studies are needed to fully assess the safety and efficacy of TXA in GI bleeding, particularly in different patient populations and with varying dosing regimens 3, 6.