From the Guidelines
Tranexamic acid (TXA) should not be used as a primary treatment to stop a gastrointestinal (GI) bleed outside of clinical trials, due to limited evidence of its effectiveness in this context and potential risks. For acute management of GI bleeding, the use of TXA is still being investigated, and its benefits are not well established, as seen in the guidelines from the British Society of Gastroenterology 1. While TXA has been shown to improve mortality in trauma patients and has some evidence of benefit in acute upper GI bleeding, its use in lower GI bleeding is less clear, and more research is needed to fully understand its effects 1.
In certain cases, such as hereditary hemorrhagic telangiectasia (HHT), TXA may be recommended for patients with mild GI bleeding due to its low potential for harm, but the evidence for its effectiveness is limited 1. The guidelines for HHT recommend systemic therapies, including TXA, as the primary modality for managing GI bleeding, but also emphasize the need for further research to determine the optimal treatment approach 1.
When considering the use of TXA in GI bleeding, it is essential to weigh the potential benefits against the risks, including the theoretical risk of thromboembolism, and to prioritize definitive treatments like endoscopy for identifying and directly treating the bleeding source. The administration of TXA should be individualized and based on the specific clinical context, taking into account the severity of the bleeding, the patient's overall health, and the availability of other treatment options.
Key points to consider when using TXA in GI bleeding include:
- Limited evidence of effectiveness in lower GI bleeding
- Potential risks, including thromboembolism
- Need for further research to determine optimal treatment approach
- Importance of individualizing treatment and prioritizing definitive treatments like endoscopy
- Recommendation for use in mild GI bleeding in certain cases, such as HHT, due to low potential for harm 1.
From the Research
Efficacy of Tranexamic Acid in Gastrointestinal Bleeding
- Tranexamic acid (TXA) has been studied as a potential treatment for gastrointestinal (GI) bleeding, with mixed results 2, 3, 4, 5, 6.
- A 2018 double-blind randomized controlled trial found that TXA reduced the need for urgent endoscopy in patients with acute GI bleeding, but did not significantly affect mortality, re-bleeding, or blood transfusion rates 2.
- A 2022 systematic review and meta-analysis found that extended-use high-dose IV TXA did not improve mortality or bleeding outcomes, but increased adverse events such as deep venous thrombosis and pulmonary embolism 3.
- A 2021 systematic review and meta-analysis found that TXA significantly reduced continued bleeding, urgent endoscopic intervention, and mortality in patients with upper GI bleeding 4.
- A 2008 systematic review found that TXA may reduce all-cause mortality in patients with upper GI bleeding, but additional evidence is needed to confirm this finding 5.
- A 2017 retrospective cohort study found that TXA was more often prescribed to patients with more severe GI bleeding ulcer disease, but further investigation is needed to conclude its significance 6.
Mechanism of Action and Potential Benefits
- TXA is a synthetic antifibrinolytic drug that works by inhibiting the breakdown of fibrin clots, which can help to reduce bleeding 2, 3, 4.
- The potential benefits of using TXA in GI bleeding include reducing the need for urgent endoscopy, decreasing mortality, and stabilizing patients before endoscopic treatments 2, 4, 5.