From the Research
Tranexamic acid can be considered for managing upper GI bleeding in COATS Plus syndrome, though evidence specific to this rare condition is limited. The recommended dosing is 1 gram intravenously every 6-8 hours for 24-48 hours during active bleeding episodes, as suggested by studies on gastrointestinal bleeding in general 1. For patients with renal impairment, dose adjustment is necessary. Treatment should begin as soon as possible after bleeding onset, ideally within 3 hours for maximum benefit. Tranexamic acid works as an antifibrinolytic agent by inhibiting plasminogen activation, thereby stabilizing blood clots and reducing bleeding.
In COATS Plus syndrome, which features cerebral small vessel disease, retinal telangiectasias, and GI bleeding from vascular ectasias, tranexamic acid may help control the recurrent GI hemorrhage that characterizes the condition, as seen in cases of severe gastrointestinal bleeding in patients with this syndrome 2, 3. However, this treatment should be part of a comprehensive approach including endoscopic management when possible. Caution is warranted regarding thromboembolic risk, especially given the vascular abnormalities in COATS Plus syndrome, and treatment should be limited to the acute bleeding phase rather than used long-term, as noted in studies on the use of tranexamic acid in gastrointestinal bleeding 4, 5.
Key considerations in the management of upper GI bleeding in COATS Plus syndrome include:
- Prompt initiation of tranexamic acid treatment to maximize its benefits
- Careful monitoring for signs of thromboembolic events
- Integration with other treatments, such as endoscopic management, to control bleeding
- Adjustment of tranexamic acid dosing in patients with renal impairment
- Limiting treatment to the acute bleeding phase to minimize risks.