From the Guidelines
Tranexamic acid (TXA) should not be relied upon to stop a gastrointestinal (GI) bleed due to limited and inconsistent evidence of its effectiveness in this context. While TXA is an antifibrinolytic agent that helps prevent blood clot breakdown, its use in GI bleeding is not supported by strong evidence. According to a study published in Blood in 2021 1, TXA is recommended for patients with mild GI bleeding due to its low potential for harm, but there is limited evidence of its effectiveness. Another study published in Gut in 2019 1 suggests that the use of TXA in acute lower gastrointestinal bleeding should be confined to clinical trials, pending the results of further research.
Some key points to consider when managing GI bleeding include:
- Hemodynamic stabilization
- Identifying the bleeding source
- Applying appropriate targeted therapies based on the specific cause of the GI bleed
- Use of proton pump inhibitors, endoscopic interventions, and blood product transfusions as needed
It's also important to note that TXA works by inhibiting plasminogen activation, which prevents the breakdown of fibrin clots, but this mechanism may not be sufficient for the complex nature of GI bleeding where active arterial bleeding or portal hypertension may be involved. Therefore, TXA should not be used as a primary treatment for GI bleeding, and other evidence-based treatments should be prioritized.