From the Guidelines
Tranexamic acid (TXA) should not be used as a standard treatment to stop a gastrointestinal (GI) bleed outside of clinical trials, due to uncertain benefits and potential risks. The use of TXA in acute GI bleeding has been studied, but the evidence is not strong enough to support its routine use 1. While some trials have shown a potential benefit of TXA in reducing mortality from upper GI bleeding, with a 40% risk reduction in mortality 1, this benefit was not seen in trials with low risk of bias. Additionally, the studies were considered historic and did not reflect modern day care with high-dose acid suppression and endoscopic therapy 1.
The British Society of Gastroenterology guidelines suggest that the use of TXA in acute lower GI bleeding should be confined to clinical trials, pending the results of the HALT-IT trial 1. The potential side effects of TXA, including nausea, vomiting, and diarrhea, as well as a theoretical risk of thrombotic events, must also be considered.
In clinical practice, standard treatments for GI bleeding, such as endoscopic intervention, proton pump inhibitors, and correction of coagulopathies, should be prioritized. TXA may be considered as an adjunct to these treatments in specific situations, such as hyperfibrinolysis, but its use should be individualized and carefully monitored. Overall, the uncertain benefits and potential risks of TXA in GI bleeding make it a treatment that should be used with caution and only in the context of clinical trials or specific clinical scenarios.
From the Research
Tranexamic Acid (TXA) in Gastrointestinal (GI) Bleeding
- TXA has been studied as a potential treatment for GI bleeding, with mixed results 2, 3, 4, 5, 6
- A systematic review and meta-analysis found that TXA significantly reduced the rates of continued bleeding, urgent endoscopic intervention, and mortality in patients with upper GI bleeding 2
- However, another study found that TXA did not reduce death from GI bleeding, and may even increase the risk of venous thromboembolic events 4
- A double-blind prospective randomized controlled trial found that intravenous TXA had no significant effect on blood transfusion requirements in patients with lower GI bleeding 5
- A systematic review and meta-analysis found that extended-use high-dose IV TXA did not reduce mortality or bleeding outcomes, but may increase adverse events, while low-dose IV/enteral TXA may be effective in reducing hemorrhage 6
Key Findings
- TXA may be effective in reducing bleeding and mortality in upper GI bleeding, but its effectiveness in lower GI bleeding is unclear 2, 5
- High-dose IV TXA may increase the risk of adverse events, such as venous thromboembolic events and seizures 4, 6
- Low-dose IV/enteral TXA may be effective in reducing hemorrhage, but more evidence is required to demonstrate its safety 6