From the Guidelines
Tranexamic acid (TXA) should not be used as a primary treatment for gastrointestinal (GI) bleeding, as evidence for its effectiveness in this context is limited and conflicting. For acute GI bleeding, standard treatments include proton pump inhibitors, endoscopic interventions, and blood product transfusions as needed 1. TXA works by blocking 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 even increase the risk of venous thromboembolic events in patients with GI bleeding, particularly in those with comorbid liver disease or suspected variceal bleeding 1. The most recent and highest quality study on this topic, published in 2022, found no beneficial effect of TXA in patients with acute upper gastrointestinal bleeding, and actually found an increased risk of venous thromboembolic events in the TXA group compared to the placebo group 1.
Therefore, if faced with a GI bleed, focus on:
- Hemodynamic stabilization
- Identifying the bleeding source through endoscopy
- Applying appropriate direct interventions, such as endoscopic therapy or surgery, rather than relying on TXA as a primary treatment option. In patients with cirrhosis and active variceal bleeding, portal hypertension-lowering drugs and endoscopic treatment should be used to achieve haemostasis, and TXA should not be used 1.
In summary, while TXA may be effective in certain types of bleeding, its use in GI bleeding is not supported by strong evidence, and it may even increase the risk of adverse events. Therefore, TXA should not be used as a primary treatment for GI bleeding, and standard treatments should be prioritized instead.