From the Guidelines
Tranexamic acid (TXA) should not be used as a first-line treatment to stop a gastrointestinal (GI) bleed, as it has not demonstrated clear mortality benefits or superiority over standard treatments. For acute GI bleeds, standard treatments include proton pump inhibitors, endoscopic interventions, and blood product transfusions as needed 1. TXA works by inhibiting plasminogen activation, which prevents the breakdown of formed clots, but studies have shown inconsistent results for GI bleeding specifically. Some research suggests it may provide modest benefits in certain cases, but it hasn't demonstrated clear mortality benefits or superiority over standard treatments.
Key Points to Consider
- Patients with GI bleeding should be promptly assessed for hemodynamic stability, have IV access established, receive appropriate fluid resuscitation, and undergo endoscopic evaluation, which remains the cornerstone of diagnosis and treatment.
- The use of TXA in GI bleeding is not recommended, as it may increase the risk of venous thromboembolic events, particularly in patients with comorbid liver disease or suspected variceal bleeding 1.
- Standard therapy for variceal bleeding includes prompt initiation of vasoactive therapy, antibiotics, and endoscopic band ligation, rather than TXA 1.
- In patients with hereditary hemorrhagic telangiectasia (HHT), TXA may be considered for mild GI bleeding, but its effectiveness is limited, and systemic bevacizumab is recommended for moderate or severe GI bleeding 1.
Treatment Approach
- For acute GI bleeds, focus on standard treatments, including proton pump inhibitors, endoscopic interventions, and blood product transfusions as needed.
- Consider the underlying cause of the GI bleed and tailor treatment accordingly.
- If considering TXA for GI bleeding in specific circumstances, the typical dose is 1g IV every 8 hours, but this should only be done under specialist guidance.