Can tranexamic acid (TXA) stop a gastrointestinal (GI) bleed?

From the Guidelines

Tranexamic acid (TXA) should not be used as a primary treatment to stop a gastrointestinal (GI) bleed. While TXA is an antifibrinolytic agent that helps prevent blood clot breakdown and is effective for certain types of bleeding, its role in GI bleeding is limited. For acute GI bleeds, standard treatments include proton pump inhibitors (such as pantoprazole 40mg IV twice daily), endoscopic interventions, and blood product transfusions as needed. 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 of TXA was observed in the whole group nor in the subgroup analysis of patients with suspected variceal bleeding and liver disease comorbidity. Additionally, there are concerns about potential side effects including thrombotic complications when used for GI bleeding, as noted in the study 1.

Some key points to consider when managing GI bleeding include:

• Standard treatments such as acid suppression, endoscopic therapy, and addressing the underlying cause are recommended
• TXA may provide modest benefits in certain cases, but the evidence isn't strong enough to support routine use
• There are concerns about potential side effects including thrombotic complications when used for GI bleeding
• The use of TXA in GI bleeding is not recommended, as stated in the guidelines 1 and 1.

In terms of specific patient populations, such as those with cirrhosis, the guidelines recommend against the use of TXA in patients with cirrhosis and active variceal bleeding 1. Instead, portal hypertension-lowering drugs and endoscopic treatment should be used to achieve haemostasis, and correction of haemostatic abnormalities should not be indicated unless there is failure to control haemorrhage.

Overall, the evidence suggests that TXA should not be used as a primary treatment to stop a GI bleed, and instead, standard treatments and guidelines should be followed.