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.
The primary treatments for GI bleeding typically include:
- Proton pump inhibitors (like pantoprazole 40mg IV twice daily)
- Endoscopic interventions to directly treat the bleeding source
- Correction of any coagulopathy These treatments should be used as part of a comprehensive approach to GI bleeding management. The use of tranexamic acid may be considered in specific cases, but it is not recommended as a first-line therapy for most GI bleeds.
It's also important to note that the British Society of Gastroenterology guidelines published in 2019 1 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. However, the more recent study published in 2022 1 provides higher quality evidence and suggests that tranexamic acid should not be used to stop a GI bleed.
In patients with cirrhosis and active variceal bleeding, the guidelines recommend against the use of tranexamic acid (LoE 2, strong recommendation) 1. The medication may be associated with an increased risk of thromboembolic events, particularly in patients with comorbid liver disease or suspected variceal bleeding.
In summary, the current evidence suggests that tranexamic acid should not be used as a first-line treatment for GI bleeding, and its use should be limited to specific cases or clinical trials.
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.