From the Guidelines
Tranexamic acid (TXA) should not be used to stop a gastrointestinal (GI) bleed, as the most recent and highest quality evidence suggests it does not provide a significant benefit in reducing mortality or improving outcomes in patients with GI bleeding. 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 reducing death due to bleeding within the first 5 days. Furthermore, the study reported an almost 2-fold increase in the incidence of venous thromboembolic events in the tranexamic acid group compared to the placebo group.
The primary treatments for GI bleeding typically include:
- Endoscopic interventions
- Proton pump inhibitors (like pantoprazole 40mg IV twice daily)
- Addressing the underlying cause These treatments are considered first-line therapy for most GI bleeds, and tranexamic acid is not recommended as a standalone therapy for GI bleeding. The use of tranexamic acid may be considered in specific scenarios, such as bleeding related to esophageal varices or when endoscopic treatment is delayed or unavailable, but its use should be guided by the specific cause and severity of the bleed.
It is essential to note that the British Society of Gastroenterology guidelines published in 2019 1 suggested that the use of tranexamic acid in acute lower GI bleeding should be confined to clinical trials, pending the results of the HALT-IT trial. However, the more recent study published in 2022 1 provides higher quality evidence and suggests that tranexamic acid should not be used to stop a GI bleed.
In patients with cirrhosis and active variceal bleeding, the guidelines recommend against the use of tranexamic acid (LoE 2, strong recommendation) 1. The medication works by inhibiting plasminogen activation, preventing the dissolution of fibrin clots that form to stop bleeding, but its use is not recommended due to the lack of benefit in reducing mortality or improving outcomes in patients with GI bleeding.