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 even increase the risk of thromboembolic events. The most recent and highest quality study, a large randomized placebo-controlled trial including 12,009 patients with acute upper gastrointestinal bleeding 1, found no beneficial effect of tranexamic acid in reducing mortality due to bleeding, and actually observed an increased incidence of venous thromboembolic events in the tranexamic acid group. Other studies have also failed to demonstrate a consistent mortality benefit with TXA use in GI bleeding 1. For acute GI bleeding, standard treatments include proton pump inhibitors, endoscopic interventions, and blood product transfusions as needed. TXA works by inhibiting plasminogen activation, but this mechanism may not adequately address the complex nature of GI bleeding, which often requires direct intervention at the bleeding site.
Some key points to consider when managing a GI bleed include:
- Hemodynamic stabilization is crucial to prevent shock and organ failure
- Early endoscopy is essential to identify and treat the underlying cause of bleeding
- Blood product transfusions may be necessary to replace lost blood and maintain oxygen delivery to tissues
- TXA may be considered in specific cases, such as hereditary hemorrhagic telangiectasia with mild GI bleeding, but its use should be individualized and carefully weighed against potential risks 1.
In general, the management of GI bleeding should focus on treating the underlying cause and stabilizing the patient, rather than relying on TXA as a primary intervention.