From the Guidelines

Tranexamic Acid (TXA) is not recommended to stop a gastrointestinal (GI) bleed.

The use of tranexamic acid in acute GI bleeding has been evaluated in several studies, but the evidence is not strong enough to support its routine use 1.
A large randomized placebo-controlled trial including 12,009 patients with acute upper gastrointestinal bleeding found no beneficial effect of tranexamic acid on mortality, and an increased risk of venous thromboembolic events 1.
The EASL clinical practice guidelines on prevention and management of bleeding and thrombosis in patients with cirrhosis recommend against the use of tranexamic acid in patients with cirrhosis and active variceal bleeding, and also discourage its routine use in patients with cirrhosis undergoing invasive procedures 1.
A meta-analysis of tranexamic acid therapy in non-variceal upper gastrointestinal haemorrhage found that it tends to reduce mortality in ulcer bleeding patients, but further studies are necessary before it can be recommended as routine therapy 1.

Tranexamic acid may increase the risk of venous thromboembolic events, particularly in patients with cirrhosis and suspected variceal bleeding.
The use of tranexamic acid should be considered on a case-by-case basis, and only in the context of clinical trials or when other treatment options have failed.
Standard therapy for variceal bleeding includes prompt initiation of vasoactive therapy, antibiotics, and endoscopic treatment, and correction of haemostatic abnormalities is not indicated if haemostasis is achieved with these measures 1.

From the Research

Tranexamic acid (TXA) has been studied for its potential to stop gastrointestinal (GI) bleeding, with evidence suggesting it may be effective in reducing rebleeding and mortality in patients with upper GI bleeding 2, 3, 4, 5.
A systematic review and meta-analysis of randomized controlled trials found that TXA significantly reduced the rates of continued bleeding, urgent endoscopic intervention, and mortality compared to placebo in patients with upper GI bleeding 3.
Another study found that TXA may reduce all-cause mortality in patients with upper GI bleeding, but noted that additional evidence is needed to confirm this finding due to limitations in the internal and external validity of included trials 4.
The HALT-IT trial, a large international randomized controlled trial, aimed to provide reliable evidence on the effects of TXA in acute upper and lower GI bleeding, with primary outcomes including death due to bleeding within 5 days of randomization and secondary outcomes such as rebleeding and thromboembolic events 6.

The evidence suggests that TXA does not increase the risk of thromboembolic adverse effects in patients with upper GI bleeding 2, 4.
However, the effects of TXA on lower GI bleeding warrant further clarification, and additional higher-quality trials are needed to fully understand the safety and efficacy of TXA in GI bleeding 3, 5.

Moderate-quality evidence supports the use of TXA for reducing mortality in patients with upper GI bleeding, with a significant reduction in risk of death compared to placebo 5.
Early administration of TXA may be recommended for treating upper GI bleeding in the emergency department, but further research is needed to confirm this finding and to fully understand the effects of TXA in GI bleeding 3.