From the Guidelines
Tranexamic acid (TXA) should not be used as a first-line treatment for gastrointestinal (GI) bleeding, as the evidence supporting its routine use is not strong and it may even increase the risk of venous thromboembolic events. While TXA is an antifibrinolytic agent that helps prevent blood clot breakdown and is effective for certain types of bleeding, its role in GI bleeding is limited. For acute GI bleeds, standard treatments include proton pump inhibitors (such as pantoprazole 40mg IV twice daily), endoscopic interventions, and blood product transfusions as needed. According to a recent study 1, TXA may even increase the risk of venous thromboembolic events, particularly in patients with comorbid liver disease or suspected variceal bleeding. The mechanism of TXA involves inhibiting plasminogen activation, which stabilizes formed clots, but this may not adequately address the underlying causes of most GI bleeds, which often require direct intervention at the bleeding site.
Some key points to consider when managing GI bleeding include:
- Prompt evaluation by a healthcare provider to determine the cause and severity of bleeding
- Use of standard treatments such as proton pump inhibitors, endoscopic interventions, and blood product transfusions as needed
- Consideration of TXA as an adjunctive therapy in specific cases of severe GI bleeding when other treatments have failed, but with caution due to the potential increased risk of venous thromboembolic events
- Monitoring for bleeding complications and adjusting treatment as needed
It's also important to note that the use of TXA in GI bleeding is not recommended by recent guidelines 1, and its use should be carefully considered on a case-by-case basis. Patients with GI bleeding should be managed according to the specific cause and severity of their bleeding, and treatment should be tailored to their individual needs.