From the Guidelines
Tranexamic acid (TXA) should not be used as a primary treatment to stop a gastrointestinal (GI) bleed, as the evidence for its effectiveness in this context is limited and conflicting, and it may increase the risk of thrombotic complications. For acute GI bleeding, standard treatments include proton pump inhibitors, endoscopic interventions, and blood product transfusions as needed. TXA works by inhibiting plasminogen activation, which prevents the breakdown of fibrin clots, but this mechanism may not adequately address the complex nature of GI bleeding, which often requires direct intervention at the bleeding site.
Some studies have shown that TXA may have a beneficial effect in certain GI bleeding scenarios, such as in patients with hereditary hemorrhagic telangiectasia (HHT) with mild GI bleeding 1. However, the evidence is not strong enough to support its routine use in GI bleeding, and the potential risks of thrombotic complications must be weighed against any potential benefits. A large randomized controlled trial found that TXA did not reduce mortality from GI bleeding and may have increased the risk of venous thromboembolic events, particularly in patients with liver disease 1.
In patients with cirrhosis and active variceal bleeding, the use of TXA is not recommended due to the lack of evidence for its effectiveness and the potential for increased thrombotic risk 1. The British Society of Gastroenterology guidelines suggest that the use of TXA in acute lower GI bleeding should be confined to clinical trials, pending the results of further studies 1.
In summary, while TXA may have a role in certain specific scenarios, such as in patients with HHT and mild GI bleeding, it should not be used as a primary treatment for GI bleeding in general, and standard treatments such as proton pump inhibitors, endoscopic interventions, and blood product transfusions should be prioritized. If you're dealing with a GI bleed, seek immediate medical attention and follow established treatment guidelines rather than relying on TXA as a primary intervention.