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 patients with acute upper gastrointestinal bleeding, and even suggested 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, and actually increased the risk of venous thromboembolic events 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, may not be effective in all types of GI bleeding, particularly variceal bleeding 1.
- The potential side effects of TXA, including nausea, vomiting, diarrhea, and thromboembolic events, must be carefully considered and monitored in patients receiving this treatment 1.
- The use of TXA as part of a comprehensive treatment approach, including endoscopic intervention, proton pump inhibitors, and other supportive measures, may be necessary to effectively manage GI bleeding, but the evidence suggests that TXA should not be used as a first-line treatment 1. It is essential to prioritize the most recent and highest quality evidence when making treatment decisions, and in this case, the evidence suggests that TXA should not be used to stop a GI bleed 1.
From the Research
Effectiveness of Tranexamic Acid in GI Bleeding
- Tranexamic acid (TXA) has been shown to be effective in reducing bleeding in patients with upper gastrointestinal bleeding, with a significant reduction in continued bleeding, urgent endoscopic intervention, and mortality compared to placebo 2.
- A double-blind randomized controlled trial found that early intravenous and/or intravenous plus topical administration of TXA reduced the need for urgent endoscopy for acute gastrointestinal bleeding 3.
- The HALT-IT trial, an international, randomized, double-blind, placebo-controlled trial, aims to provide reliable evidence about the effects of TXA in acute upper and lower GI bleeding, with primary outcomes including death due to bleeding within 5 days of randomization and secondary outcomes such as rebleeding and thromboembolic events 4.
Limitations and Variability in Effectiveness
- The effectiveness of TXA in lower gastrointestinal bleeding is less clear, with one study finding no significant effect on blood transfusion requirements in patients with lower GI bleeding 5.
- A systematic review of randomized trials on TXA for upper gastrointestinal bleeding found that TXA may reduce all-cause mortality, but additional evidence is needed due to limitations in the internal and external validity of included trials 6.
- The variability in study findings highlights the need for further research to fully understand the effectiveness of TXA in GI bleeding, particularly in different patient populations and bleeding locations.
Key Findings and Implications
- TXA has been shown to be effective in reducing bleeding and improving outcomes in patients with upper gastrointestinal bleeding, but its effectiveness in lower GI bleeding is uncertain.
- Early administration of TXA may be beneficial in treating upper gastrointestinal bleeding in the emergency department, but further clarification is needed on its effects in lower GI bleeding.
- The results of ongoing and future studies, such as the HALT-IT trial, will provide valuable insights into the effectiveness and safety of TXA in GI bleeding, informing treatment recommendations and guidelines 2, 3, 4, 5, 6.