From the Guidelines
Tranexamic acid (TXA) should not be used to stop a gastrointestinal (GI) bleed, as the most recent and highest quality evidence does not support its effectiveness in this context. 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 stopping the bleed, and even reported an increased incidence of venous thromboembolic events in the tranexamic acid group.
The primary treatments for GI bleeding typically include:
- Endoscopic interventions
- Proton pump inhibitors (like pantoprazole 40mg IV twice daily)
- Addressing the underlying cause TXA may be considered in specific scenarios, but its use is not recommended as a first-line therapy for most GI bleeds. The medication works by inhibiting plasminogen activation, which prevents the dissolution of fibrin clots that form at bleeding sites.
It's also important to note that management of GI bleeding should be comprehensive, addressing the specific cause and location of bleeding rather than relying solely on any single treatment, including TXA. 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 further studies. However, the more recent study from 2022 1 provides stronger evidence against the use of TXA in GI bleeding.
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.