From the Guidelines
Tranexamic acid (TXA) should not be used to stop a gastrointestinal (GI) bleed, as the most recent and highest quality evidence suggests it does not provide a significant benefit in reducing mortality or improving outcomes in patients with GI bleeding. According to the study published in the Journal of Hepatology in 2022 1, a large randomized placebo-controlled trial including 12,009 patients with acute upper gastrointestinal bleeding found no beneficial effect of tranexamic acid in reducing death due to bleeding within the first 5 days. Furthermore, the study reported an almost 2-fold increase in the incidence of venous thromboembolic events in the tranexamic acid group compared to the placebo group.
Key Points to Consider
- The use of tranexamic acid in GI bleeding is not supported by recent evidence, and its use may be associated with an increased risk of thromboembolic events 1.
- The British Society of Gastroenterology guidelines suggest that the use of tranexamic acid in acute lower GI bleeding should be confined to clinical trials, pending the results of the HALT-IT trial 1.
- The management of GI bleeding should focus on identifying and addressing the underlying cause of the bleed, rather than relying solely on pharmacological interventions.
- Other treatments, such as proton pump inhibitors, endoscopic interventions, or surgical management, may be more effective in managing GI bleeding, and should be considered as part of a comprehensive treatment plan.
Important Considerations
- Patients with active thromboembolic disease should not receive tranexamic acid, and caution should be used in those with renal impairment, requiring dose adjustment.
- The use of blood products, such as fresh frozen plasma or platelet concentrate, may also be associated with an increased risk of thromboembolic events, and should be used judiciously in patients with GI bleeding 1.
From the Research
Effectiveness of Tranexamic Acid in Gastrointestinal Bleeding
- Tranexamic acid (TXA) has been shown to be effective in reducing bleeding in patients with upper gastrointestinal bleeding 2, 3.
- A systematic review and meta-analysis of randomized clinical trials found that TXA significantly reduced the rates of continued bleeding, urgent endoscopic intervention, and mortality compared to placebo 2.
- A double-blind randomized controlled trial found that early administration of TXA reduced the need for urgent endoscopy and improved outcomes for patients with acute gastrointestinal bleeding 3.
Timing of Tranexamic Acid Administration
- A population-based cohort study found that early TXA administration was associated with a reduced risk of mortality in patients with gastrointestinal bleeding, without an increase in thromboembolic events 4.
- The study suggested that early TXA treatment may be beneficial in reducing mortality, but further randomized clinical trials are needed to confirm this finding.
Effectiveness of Tranexamic Acid in Lower Gastrointestinal Bleeding
- A double-blind prospective randomized controlled trial found that intravenous TXA had no significant effect on blood transfusion requirements in patients with lower gastrointestinal bleeding 5.
- The study suggested that TXA may not be effective in reducing bleeding in patients with lower gastrointestinal bleeding, but further studies are needed to confirm this finding.
Overall Evidence
- The current evidence suggests that TXA is effective in reducing bleeding in patients with upper gastrointestinal bleeding, but its effectiveness in lower gastrointestinal bleeding is uncertain 2, 3, 5.
- Further studies are needed to confirm the effectiveness of TXA in gastrointestinal bleeding and to determine the optimal timing and dosage of TXA administration 6, 4.