From the Research
Tranexamic acid (TXA) can be effective in managing certain types of gastrointestinal (GI) bleeding, particularly upper GI bleeding, by reducing the rates of continued bleeding, urgent endoscopic intervention, and mortality, as shown in a recent systematic review with meta-analysis of randomized clinical trials 1. The use of TXA in GI bleeding is supported by its mechanism of action, which involves inhibiting the breakdown of blood clots, thereby helping to control bleeding in the GI tract.
- For acute upper GI bleeding, TXA is typically administered at a dose of 1g intravenously every 6-8 hours for 24-48 hours, or until bleeding is controlled.
- In some cases, oral administration at 1-1.5g three to four times daily may be used for less severe bleeding or as follow-up therapy.
- TXA appears most beneficial when given early in the course of bleeding, ideally within the first 3-4 hours. However, the effectiveness of TXA in lower GI bleeding is less clear, with a recent double-blind prospective randomized controlled trial finding no significant effect on blood transfusion requirements 2. It is essential to use TXA as part of a comprehensive management approach that may include endoscopic intervention, proton pump inhibitors, and correction of coagulopathies, and to exercise caution in patients with a history of thromboembolic disease, as TXA could potentially increase the risk of clot formation in undesired locations 1, 3, 4.