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 re-bleeding rates, and may even increase the risk of thromboembolic events. According to the 2022 guidelines from the Journal of Hepatology 1, TXA is not recommended for use in patients with cirrhosis and active variceal bleeding, as it has been shown to have no beneficial effect in preventing re-bleeding or reducing mortality, and may even increase the risk of venous thromboembolic events. The primary treatments for GI bleeding typically include endoscopic interventions, proton pump inhibitors, and addressing the underlying cause.
While TXA may have been considered for use in certain scenarios, such as bleeding associated with esophageal varices, the most recent evidence suggests that its use is not justified due to the lack of benefit and potential risks. The 2019 guidelines from the British Society of Gastroenterology 1 also suggest that the use of TXA in acute lower GI bleeding should be confined to clinical trials, pending the results of further studies. However, the more recent 2022 guidelines from the Journal of Hepatology 1 provide stronger evidence against the use of TXA in GI bleeding, and should be prioritized in clinical decision-making.
In terms of specific patient populations, the evidence suggests that TXA is not beneficial in patients with cirrhosis and variceal bleeding, and may even be harmful due to the increased risk of thromboembolic events. For patients with non-variceal bleeding, the evidence is less clear, but the primary treatments for GI bleeding, such as endoscopic interventions and proton pump inhibitors, should still be prioritized.
Overall, the use of TXA in GI bleeding should be approached with caution, and alternative treatments should be prioritized due to the lack of benefit and potential risks associated with TXA.