From the Guidelines
Tranexamic acid (TXA) should not be used as a first-line treatment to stop a gastrointestinal (GI) bleed, as its effectiveness is less established compared to other treatments and it may carry risks of thrombotic complications. For acute GI bleeding, the primary treatments remain endoscopic intervention to directly treat the bleeding source, proton pump inhibitors for upper GI bleeds, correction of coagulopathy, and blood product transfusion as needed 1. TXA may be considered as an adjunctive therapy in specific cases, such as when endoscopy is delayed or unavailable, or in patients with continued bleeding despite standard interventions. However, its use should be carefully considered due to the potential risks of thrombotic complications, especially in patients with pre-existing cardiovascular disease or other risk factors for thrombosis 1.
Some studies suggest that TXA may have a beneficial effect in reducing mortality in patients with acute upper gastrointestinal bleeding, but these findings are not consistent across all studies and the evidence is not strong enough to support its routine use in GI bleeding 1. In fact, a large randomized placebo-controlled trial found no beneficial effect of TXA in patients with acute upper gastrointestinal bleeding, and an increased risk of venous thromboembolic events was observed in the TXA group 1.
In patients with cirrhosis and active variceal bleeding, the use of TXA is not recommended due to the lack of evidence supporting its effectiveness and the potential risks of thrombotic complications 1. The management of GI bleeding in these patients should focus on endoscopic intervention, vasoactive therapy, antibiotics, and blood product transfusion as needed.
In summary, while TXA may have a role in the management of GI bleeding in specific cases, its use should be carefully considered and it should not be used as a first-line treatment due to the potential risks and lack of strong evidence supporting its effectiveness. The primary treatments for GI bleeding remain endoscopic intervention, proton pump inhibitors, correction of coagulopathy, and blood product transfusion as needed.