Can tranexamic acid (TXA) stop a gastrointestinal (GI) bleed?

From the Guidelines

Tranexamic acid (TXA) should not be used to stop a gastrointestinal (GI) bleed, as the most recent and highest quality evidence does not support its effectiveness in this context [ 1 ]. The use of TXA in GI bleeding has been evaluated in several studies, but the results have been inconsistent and often limited by methodological flaws. A large randomized placebo-controlled trial including 12,009 patients with acute upper gastrointestinal bleeding found no beneficial effect of TXA in reducing mortality due to bleeding, and actually observed an increased incidence of venous thromboembolic events in the TXA group [ 1 ].

Key Points to Consider

• The mechanism of action of TXA, which involves inhibiting plasminogen activation to prevent fibrin clot breakdown, may not be effective in addressing the underlying causes of GI bleeding [ 1 ].
• Standard treatments for acute GI bleeding, such as proton pump inhibitors, endoscopic interventions, and vasopressors, are generally more effective and recommended as first-line therapies [ 1 ].
• The potential risks of TXA, including thrombotic complications, must be carefully weighed against any potential benefits, particularly in patients with underlying liver disease or other comorbidities [ 1 ].

Clinical Implications

• Patients with GI bleeding should seek immediate medical attention for proper diagnosis and treatment tailored to the specific cause and location of bleeding.
• Clinicians should exercise caution when considering the use of TXA in GI bleeding, and carefully evaluate the potential risks and benefits in each individual case.
• Further research is needed to fully understand the role of TXA in GI bleeding, but current evidence does not support its routine use in this context [ 1 ].

From the Research

Effectiveness of Tranexamic Acid (TXA) in Stopping GI Bleed

• The effectiveness of TXA in stopping GI bleed is a topic of ongoing research, with studies yielding mixed results 2, 3, 4, 5, 6.
• A study published in 2021 found that TXA had no significant positive effect on patients with upper gastrointestinal bleeding 2.
• In contrast, a systematic review and meta-analysis published in 2021 found that TXA significantly reduced the rates of continued bleeding, urgent endoscopic intervention, and mortality in patients with upper gastrointestinal bleeding 3.
• Another study published in 2008 found that TXA may reduce all-cause mortality in patients with upper gastrointestinal bleeding, but additional evidence is needed to confirm this finding 4.
• A pilot study published in 2003 found that TXA was beneficial as adjunctive therapy in treating major upper gastrointestinal bleeding in dialysis patients 5.
• A double-blind prospective randomized controlled trial published in 2024 found that intravenous TXA had no significant effect on blood transfusion in patients with lower gastrointestinal bleeding 6.

Key Findings

• TXA may be effective in reducing bleeding and mortality in patients with upper gastrointestinal bleeding 3, 4.
• TXA may not be effective in reducing bleeding or transfusion requirements in patients with lower gastrointestinal bleeding 6.
• The use of TXA in GI bleeding management may depend on the specific patient population and clinical context 2, 5.

Study Limitations

• The studies had varying sample sizes, study designs, and patient populations, which may limit the generalizability of the findings 2, 3, 4, 5, 6.
• Some studies had methodological limitations, such as lack of randomization or blinding, which may affect the validity of the results 2, 5.