From the Guidelines
Tranexamic acid (TXA) should not be used as a primary treatment to stop a gastrointestinal (GI) bleed due to limited and inconsistent evidence of its benefit in this context. While TXA is an antifibrinolytic agent that helps prevent blood clot breakdown and is effective for certain types of bleeding, its mechanism may not adequately address the complex nature of GI bleeding, which often requires direct visualization and intervention 1. For acute GI bleeding, standard treatments include proton pump inhibitors, endoscopic interventions to directly treat the bleeding source, and blood product transfusions as needed. Some studies have explored TXA use in GI bleeding, but major guidelines do not currently support its routine use due to insufficient evidence showing mortality benefit or reduced rebleeding rates 1.
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. Furthermore, the use of tranexamic acid was associated with an increased risk of venous thromboembolic events, particularly in patients with comorbid liver disease or suspected variceal bleeding 1.
Therefore, patients with GI bleeding should be promptly assessed for hemodynamic stability, have IV access established, and be referred for urgent endoscopy rather than relying on TXA as a primary treatment. TXA may be considered in specific cases, such as hereditary hemorrhagic telangiectasia with mild GI bleeding, but its use should be guided by individual patient needs and circumstances 1. The primary focus should be on standard treatments and interventions that have proven efficacy in managing GI bleeding and improving patient outcomes.
From the Research
Effectiveness of Tranexamic Acid (TXA) in Stopping GI Bleed
- TXA has been shown to reduce 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 may reduce all-cause mortality in patients with upper gastrointestinal bleeding, but the evidence is limited and more research is needed 3.
- Another study found that extended-use high-dose IV TXA did not reduce mortality or bleeding outcomes, but low-dose IV/enteral TXA may be effective in reducing hemorrhage 4.
- A systematic review and meta-analysis found that TXA appears to have a beneficial effect in terms of decreasing the risk of re-bleeding and decreasing the need for surgery in upper GI bleeding, but the effect on mortality is not statistically significant 5.
- A Cochrane review found that TXA appears to have a beneficial effect on mortality, but the results are not conclusive due to high dropout rates in some trials, and more research is needed 6.
Key Findings
- TXA reduces the rates of continued bleeding, urgent endoscopic intervention, and mortality in patients with upper gastrointestinal bleeding.
- TXA may reduce all-cause mortality in patients with upper gastrointestinal bleeding, but more research is needed.
- Low-dose IV/enteral TXA may be effective in reducing hemorrhage, but extended-use high-dose IV TXA does not reduce mortality or bleeding outcomes.
- TXA appears to have a beneficial effect in terms of decreasing the risk of re-bleeding and decreasing the need for surgery in upper GI bleeding.