From the Guidelines
Tranexamic acid (TXA) should not be used to stop a gastrointestinal (GI) bleed, as the most recent and highest quality evidence does not support its effectiveness in this context. According to the EASL clinical practice guidelines on prevention and management of bleeding and thrombosis in patients with cirrhosis 1, tranexamic acid is not recommended for patients with cirrhosis and active variceal bleeding. In fact, a large randomized placebo-controlled trial including 12,009 patients with acute upper gastrointestinal bleeding found no beneficial effect of tranexamic acid in the whole group or in the subgroup analysis of patients with suspected variceal bleeding and liver disease comorbidity 1.
The guidelines also highlight that the use of tranexamic acid may be associated with an increased risk of venous thromboembolic events, particularly in patients with comorbid liver disease or suspected variceal bleeding 1.
Key points to consider in managing GI bleeding include:
- Hemodynamic stabilization
- Identifying the bleeding source through endoscopy
- Applying appropriate direct hemostatic measures
- Using standard treatments such as proton pump inhibitors, endoscopic interventions, and blood product transfusions as needed
It is essential to prioritize these evidence-based approaches over the use of tranexamic acid, which lacks strong supporting evidence for GI bleeding management 1.