From the Guidelines
Tranexamic acid (TXA) can be used to help manage mild gastrointestinal bleeding, but its effectiveness is limited and it is not considered first-line therapy for acute GI bleeds. For patients with hereditary hemorrhagic telangiectasia (HHT), TXA is recommended for those with mild GI bleeding due to its low potential for harm, as stated in the guidelines 1. However, for patients with moderate or severe GI bleeding, systemic bevacizumab is recommended instead.
When considering the use of TXA in acute GI bleeding, it is essential to weigh the potential benefits against the risks. Some studies suggest that TXA may improve mortality in acute GI bleeding, with a pooled analysis showing a 40% risk reduction in mortality 1. However, this benefit was not apparent in trials with low risk of bias, and the studies were considered historic, making their extrapolation to modern day care uncertain.
Given the limited evidence of effectiveness and potential risks, TXA should be used with caution and as an adjunct to standard GI bleed management, which includes proton pump inhibitors, endoscopic interventions, and correction of coagulopathies. Potential side effects of TXA include nausea, vomiting, diarrhea, and a theoretical risk of thrombotic events, though this risk appears low in most patients without predisposing factors.
In summary of the key points:
- TXA is recommended for mild GI bleeding in HHT patients due to low potential for harm 1
- TXA may have a limited role in acute GI bleeding, with some studies suggesting improved mortality, but results are uncertain and based on historic data 1
- TXA should be used with caution and as an adjunct to standard GI bleed management
- Potential side effects of TXA include gastrointestinal symptoms and a theoretical risk of thrombotic events.