From the Guidelines
Tranexamic acid (TXA) should not be used as a first-line treatment to stop a gastrointestinal (GI) bleed, as the most recent and highest quality evidence suggests it has limited effectiveness in this context. According to the most recent guidelines from the Journal of Hepatology 1, TXA is not recommended for use in patients with cirrhosis and active variceal bleeding, as it has been shown to have no beneficial effect in reducing mortality or bleeding in this population. Additionally, the use of TXA in acute GI bleeding has been evaluated in a large randomized placebo-controlled trial, which found no beneficial effect of TXA in reducing mortality or bleeding 1.
The evidence for TXA in GI bleeding is mixed, with some studies showing modest benefits in reducing mortality and need for surgical intervention, while others show limited effectiveness 1. However, the most recent and highest quality evidence suggests that TXA should not be used as a first-line treatment for GI bleeds. Instead, standard treatments for GI bleeding, such as endoscopic intervention, proton pump inhibitors (for upper GI bleeds), and correction of any underlying coagulopathy, should be prioritized.
Potential side effects of TXA include nausea, vomiting, and an increased risk of thromboembolism, so it should be used cautiously in patients with a history of thromboembolic disease. Patients with active GI bleeding should always be assessed for hemodynamic stability and resuscitated appropriately before considering any treatment regimen.
Some key points to consider when managing GI bleeding include:
- Assessing hemodynamic stability and resuscitating patients appropriately
- Prioritizing standard treatments for GI bleeding, such as endoscopic intervention and correction of underlying coagulopathy
- Using TXA cautiously, if at all, due to its limited effectiveness and potential side effects
- Considering the use of other treatments, such as viscoelastic tests, to guide blood product use and reduce bleeding complications 1.
Overall, the most recent and highest quality evidence suggests that TXA should not be used as a first-line treatment to stop a GI bleed, and instead, standard treatments and caution should be prioritized.
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
- Some studies suggest that TXA may reduce the risk of continued bleeding, urgent endoscopic intervention, and mortality in patients with upper GI bleeding 2, 4, 6
- However, other studies have found that TXA does not improve mortality or bleeding outcomes and may increase the risk of adverse events such as deep venous thrombosis, pulmonary embolism, and seizure 3, 5
- The effects of TXA on lower GI bleeding are less clear and require further study 2, 3
Efficacy of TXA in Upper GI Bleeding
- 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
- Another study found that TXA reduced the risk of rebleeding and the need for surgery in patients with upper GI bleeding, but did not have a significant effect on mortality or thromboembolic events 4
- A randomized controlled trial found that TXA did not reduce death from GI bleeding, but did increase the risk of venous thromboembolic events 5
Safety and Adverse Events
- TXA has been associated with an increased risk of adverse events such as deep venous thrombosis, pulmonary embolism, and seizure 3, 5
- However, other studies have found that TXA does not significantly increase the risk of thromboembolic disease 4, 6
- The safety and efficacy of TXA in patients with GI bleeding require further study to fully understand its potential benefits and risks 2, 3, 4, 5, 6