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. According to the most recent and highest quality study 1, TXA has been evaluated in a large randomized placebo-controlled trial including 12,009 patients with acute upper gastrointestinal bleeding, and no beneficial effect was observed in the whole group or in the subgroup analysis of patients with suspected variceal bleeding and liver disease comorbidity. In fact, the study found an almost 2-fold increase in the incidence of venous thromboembolic events in the TXA group compared to the placebo group.
Some key points to consider when managing GI bleeding include:
- The use of TXA is not recommended in patients with cirrhosis and active variceal bleeding, as it may increase the risk of thromboembolic events 1.
- The management of GI bleeding in patients with cirrhosis should focus on standard therapies such as vasoactive therapy, antibiotics, and endoscopic treatment 1.
- The use of blood products, such as fresh frozen plasma (FFP) and platelet concentrates, should be used judiciously, as they may increase portal pressure and worsen outcomes 1.
- Tranexamic acid may be considered in patients with mild GI bleeding, but its effectiveness is limited and it should be used with caution, particularly in patients with a history of thromboembolic events 1.
Overall, the management of GI bleeding requires a careful and individualized approach, taking into account the underlying cause of the bleeding, the patient's underlying medical conditions, and the potential risks and benefits of different treatments.
From the Research
Role of Tranexamic Acid in Managing 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 risk of rebleeding in patients with upper GI bleeding 2, 3, 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 3.
- Another study found that TXA reduced rebleeding rates overall, and this effect was more pronounced in studies with a lower risk of bias 5.
- However, the evidence is not uniform, and some studies have raised concerns about the potential for thromboembolic events with TXA use 4, 5.
Efficacy of TXA in Upper and Lower GI Bleeding
- TXA appears to be more effective in reducing rebleeding and mortality in patients with upper GI bleeding compared to lower GI bleeding 3, 5.
- One study found that TXA was associated with a significant increase in mortality in patients with lower GI bleeding 5.
- The evidence for TXA use in lower GI bleeding is limited, and further studies are needed to determine its effectiveness and safety in this population 3, 4, 5.
Safety and Adverse Events
- The safety profile of TXA in GI bleeding is generally considered favorable, but there is a potential risk of thromboembolic events 4, 5.
- One study found that extended-use high-dose IV TXA increased the risk of deep venous thrombosis, pulmonary embolism, and seizure 4.
- However, another study found no definitive evidence that TXA use is associated with thromboembolic events 5.