Can tranexamic acid (TXA) stop a gastrointestinal (GI) bleed?

From the Guidelines

Tranexamic acid (TXA) should not be used to stop a gastrointestinal (GI) bleed, as the most recent and highest quality study found no beneficial effect of TXA in acute upper gastrointestinal bleeding, and even an increased risk of venous thromboembolic events 1. The use of TXA in GI bleeding has been evaluated in several studies, but the most recent and relevant study, published in 2022, found that TXA did not reduce mortality or re-bleeding rates in patients with acute upper GI bleeding, including those with suspected variceal bleeding and liver disease comorbidity 1. In fact, the study found an almost 2-fold increase in the incidence of venous thromboembolic events in the TXA group compared to the placebo group, particularly in patients with comorbid liver disease or suspected variceal bleeding 1. Some key points to consider when evaluating the use of TXA in GI bleeding include:

• The mechanism of action of TXA, which involves inhibiting the breakdown of blood clots by blocking plasminogen activation 1
• The potential benefits of TXA in reducing bleeding in certain cases, such as trauma and postpartum hemorrhage 1
• The lack of evidence supporting the use of TXA in GI bleeding, particularly in the context of variceal bleeding or liver disease 1
• The potential risks of TXA, including thrombotic events and venous thromboembolism 1 Overall, based on the most recent and highest quality evidence, TXA should not be used as a treatment for GI bleeding, and other treatment options, such as endoscopic therapy, proton pump inhibitors, and interventional radiology procedures, should be prioritized instead 1.

From the Research

Effectiveness of Tranexamic Acid in Gastrointestinal Bleeding

• Tranexamic acid (TXA) has been shown to be effective in reducing the rates of continued bleeding, urgent endoscopic intervention, and mortality in patients with upper gastrointestinal bleeding 2.
• A study found that early administration of TXA may be worth recommending for treating upper gastrointestinal bleeding in the emergency department 2.
• Another study found that TXA can aid in changing an urgent endoscopy to an elective procedure, with better outcomes for both physicians and patients 3.

Upper Gastrointestinal Bleeding

• TXA may reduce upper gastrointestinal bleeding and stabilize patients before endoscopic treatments 4.
• A systematic review suggested that TXA may reduce all-cause mortality in upper gastrointestinal bleeding, but additional evidence is needed before treatment recommendations can be made 4.

Lower Gastrointestinal Bleeding

• A study found that intravenous TXA has no significant effect on blood requirement in patients with lower GI bleeding 5.
• There was no difference in the consumption of packed red blood cells units among patients in the placebo and TXA groups in lower GI bleeding 5.

Adverse Events

• Extended-use high-dose IV TXA did not reduce mortality or bleeding outcomes but increased adverse events such as deep venous thrombosis, pulmonary embolism, and seizure 6.
• Low-dose IV/enteral TXA may be effective in reducing hemorrhage, but more evidence is required to demonstrate its safety 6.