From the Guidelines
Tranexamic acid (TXA) can be used to help manage mild gastrointestinal bleeding, but its effectiveness is limited and it is not considered a first-line treatment for most GI bleeds. TXA works by inhibiting the breakdown of blood clots, which can help reduce bleeding in certain situations 1. For patients with hereditary hemorrhagic telangiectasia (HHT), TXA is recommended for those with mild GI bleeding due to its low potential for harm, although there is limited evidence of its effectiveness 1.
In general, the evidence for TXA in GI bleeding is mixed, with some studies showing modest benefits in reducing rebleeding rates and mortality, while others show limited effectiveness 1. TXA may be more helpful in specific situations like upper GI bleeding or when endoscopic treatment is delayed or unavailable. Potential side effects include nausea, vomiting, diarrhea, and a theoretical risk of thromboembolic events, though this risk appears low in most patients.
Some key points to consider when using TXA for GI bleeding include:
- TXA should generally be used as an adjunct to more definitive treatments such as endoscopic intervention, which directly addresses the bleeding source
- The typical dose for acute GI bleeding is 1 gram given intravenously every 6-8 hours, or 1-1.5 grams orally three to four times daily
- Any patient with significant GI bleeding should receive prompt medical attention for proper diagnosis and comprehensive management, which typically includes fluid resuscitation, blood product replacement as needed, and identification and treatment of the underlying cause 1.
From the Research
Efficacy of Tranexamic Acid (TXA) in Stopping GI Bleed
- TXA has been shown to be effective in reducing the rates of continued bleeding, urgent endoscopic intervention, and mortality in patients with upper gastrointestinal bleeding 2.
- A systematic review and meta-analysis found that TXA significantly reduced rebleeding rates overall, with a more pronounced effect in studies with a lower risk of bias 3.
- TXA use was associated with a mortality reduction when administered through both oral and intravenous routes, and in cases of upper GI bleeding 3.
Reduction in Urgent Endoscopy and Surgical Intervention
- The antifibrinolytic properties of TXA can aid in changing an urgent endoscopy to an elective procedure, with better outcomes for both physicians and patients 4.
- A systematic review and meta-analysis found that TXA significantly reduced the need for surgical intervention when excluding high-risk of bias studies 3.
- TXA was also found to reduce the need for surgery in patients with upper GI bleeding, with a statistically significant risk ratio of 0.59 5.
Safety and Adverse Events
- Extended-use high-dose IV TXA was found to increase the risk of deep venous thrombosis, pulmonary embolism, and seizure, with high certainty 6.
- However, low-dose IV/enteral TXA did not reduce mortality but did reduce the risk of rebleeding and need for surgery, with moderate certainty 6.
- A systematic review and meta-analysis found no definitive evidence that TXA use is associated with thromboembolic events, but highlighted the need for cautious interpretation and individualized patient management 3.