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 has no beneficial effect in this context and may even increase the risk of venous thromboembolic events. The use of TXA in GI bleeding has been evaluated in several studies, including a large randomized placebo-controlled trial of 12,009 patients with acute upper gastrointestinal bleeding, which found no beneficial effect of TXA in reducing mortality or rebleeding rates 1. In fact, the study found an almost 2-fold increase in the incidence of venous thromboembolic events in the TXA group compared to the placebo group.
Some key points to consider when evaluating the use of TXA in GI bleeding include:
- The mechanism of action of TXA, which involves inhibiting plasminogen activation and preventing the breakdown of blood clots, may not be effective in situations where fibrinolysis is not a major contributor to ongoing bleeding
- The primary management of GI bleeding should focus on addressing the underlying cause through endoscopic intervention, acid suppression with proton pump inhibitors, or other specific treatments depending on the bleeding source
- TXA may be considered as an adjunctive therapy in certain situations, but its use should be carefully weighed against the potential risks and benefits, particularly in patients with comorbid liver disease or suspected variceal bleeding
It's also important to note that the British Society of Gastroenterology 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. However, the more recent and higher quality evidence from the 2022 study suggests that TXA should not be used in patients with cirrhosis and active variceal bleeding, and its use in other types of GI bleeding should be approached with caution 1.