From the Guidelines
Tranexamic acid (TXA) should not be relied upon as a primary treatment to stop a gastrointestinal (GI) bleed due to limited and inconsistent evidence of its effectiveness in this context. While TXA has antifibrinolytic properties that can help stabilize blood clots, its use in GI bleeding is not well-supported by current evidence 1. For patients with hereditary hemorrhagic telangiectasia (HHT) and GI bleeding, systemic therapies such as bevacizumab are recommended for moderate or severe cases, with TXA considered only for mild cases due to its low potential for harm but limited evidence of effectiveness 1.
In the management of acute GI bleeding, standard treatments include:
- Proton pump inhibitors (such as pantoprazole 40mg IV twice daily)
- Endoscopic interventions
- Vasopressors like octreotide (50-100mcg IV bolus followed by 25-50mcg/hour infusion) for variceal bleeding
- Interventional radiology procedures
TXA might be considered in specific situations when standard treatments have failed or are unavailable, typically at doses of 1g IV every 6-8 hours, but this would be an off-label use 1. The theoretical benefit of TXA in GI bleeding is its ability to prevent clot dissolution, but this must be balanced against potential risks including thrombotic complications. Patients with GI bleeding should be promptly assessed for hemodynamic stability, have IV access established, receive fluid resuscitation if needed, and undergo urgent endoscopy for diagnosis and potential therapeutic intervention.