From the Guidelines
Tranexamic acid (TXA) should not be routinely used in the management of lower gastrointestinal (GI) bleeding outside of clinical trials, as its benefit in this context is uncertain and requires further investigation. The role of TXA in lower GI bleeding is still being studied, and current guidelines suggest its use be confined to clinical trials, pending the results of the HALT-IT trial 1. While TXA has shown some benefit in reducing mortality in upper GI bleeding, with a 40% risk reduction in mortality in pooled analysis 1, this benefit is not clearly established for lower GI bleeding. The mechanism of action of TXA as an antifibrinolytic agent, inhibiting plasminogen activation and preventing the breakdown of blood clots, theoretically supports its potential use in bleeding management. However, the lack of strong evidence for its effectiveness in lower GI bleeding means that standard management should focus on:
- Hemodynamic resuscitation
- Correction of coagulopathy
- Endoscopic evaluation and intervention
- Addressing the underlying cause TXA might be considered as an adjunctive therapy in severe, ongoing cases where other interventions have failed or are not immediately available, but it should not delay definitive treatment. The dose and duration of TXA administration can vary, but typically it is given at a dose of 1g intravenously every 8 hours for up to 7 days or until bleeding stops, although this is not specifically recommended for lower GI bleeding without further evidence.
From the Research
Role of Tranexamic Acid in Lower GI Bleeding
- The evidence on the effects of tranexamic acid in patients with lower gastrointestinal bleeding is limited or highly heterogeneous 2.
- A systematic review and meta-analysis of randomized controlled trials comparing tranexamic acid with usual care or placebo in adults with gastrointestinal bleeding found that extended-use high-dose IV tranexamic acid did not reduce mortality or bleeding outcomes and increased adverse events, while low-dose IV/enteral tranexamic acid may be effective in reducing hemorrhage 3.
- Another study found that early administration of tranexamic acid may be worth recommending for treating upper gastrointestinal bleeding in the emergency department, but the effects of tranexamic acid on lower gastrointestinal bleeding warrant further clarification 2.
- There is no direct evidence in the provided studies to support the use of tranexamic acid specifically for lower GI bleeding, and more research is needed to determine its effectiveness and safety in this context.
- The use of tranexamic acid in trauma patients and other surgical procedures has been studied, and it has been found to be effective in reducing blood loss and improving survival rates, but its use in lower GI bleeding requires further investigation 4, 5.