From the Guidelines
Tranexamic acid (TXA) should not be used as a standard treatment to stop gastrointestinal (GI) bleeding outside of clinical trials, due to limited and uncertain evidence of its benefit in this context. The use of TXA in acute GI bleeding has been studied, but the results are not conclusive, and the treatment benefit for mortality was no longer apparent when the analysis was limited to trials at low risk of bias 1. While there is some evidence for its benefit in acute GI bleeding, with a 40% risk reduction in mortality in pooled analysis, this benefit is not consistently seen in higher-quality trials 1.
The current guidelines suggest that the use of TXA in acute lower GI bleeding should be confined to clinical trials, pending the results of the HALT-IT trial 1. This is because the existing studies are considered historic and were conducted before the routine use of high-dose acid suppression and endoscopic therapy, making their extrapolation to modern day care uncertain 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 side effects of TXA, including nausea, vomiting, diarrhea, and in rare cases, thromboembolic events 1
- The importance of using TXA as part of a comprehensive approach that includes other treatments such as endoscopic intervention, proton pump inhibitors, and correction of coagulopathies
- The need for further research to determine the efficacy and safety of TXA in GI bleeding, particularly in the context of modern treatment protocols 1.
From the Research
Effectiveness of Tranexamic Acid in Gastrointestinal Bleeding
- The use of tranexamic acid (TXA) in gastrointestinal (GI) bleeding has been studied in several trials, with varying results 2, 3, 4, 5, 6.
- A systematic review and meta-analysis of randomized controlled trials found that TXA significantly reduced the rates of continued bleeding, urgent endoscopic intervention, and mortality in patients with upper GI bleeding 2.
- Another study found that TXA may reduce all-cause mortality in patients with upper GI bleeding, but the evidence was limited by the heterogeneity of the included trials 3.
- A more recent systematic review and meta-analysis found that 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 4.
- Low-dose IV/enteral TXA may be effective in reducing hemorrhage, but more evidence is required to demonstrate its safety 4.
Specific Findings for Upper and Lower GI Bleeding
- For upper GI bleeding, TXA has been shown to reduce mortality, bleeding, and the need for urgent endoscopic intervention 2, 3.
- For lower GI bleeding, the evidence is less clear, with one study finding no significant effect of TXA on blood transfusion requirements 5.
- A large randomized controlled trial found that TXA did not reduce death from GI bleeding, and actually increased the risk of venous thromboembolic events 6.