From the Guidelines
Tranexamic acid (TXA) should not be used to stop a gastrointestinal (GI) bleed in patients with cirrhosis and active variceal bleeding, as it has been shown to have no beneficial effect and may increase the risk of venous thromboembolic events. According to the most recent and highest quality study, a large randomized placebo-controlled trial including 12,009 patients with acute upper gastrointestinal bleeding, of which nearly 50% of cases were suspected variceal bleeding, found no beneficial effect of TXA in the whole group nor in the subgroup analysis of patients with suspected variceal bleeding and liver disease comorbidity 1. The study also found an almost 2-fold increase in the incidence of venous thromboembolic events in the TXA group compared to the placebo group.
The use of TXA in GI bleeding is not universally recommended, and its effectiveness depends on the underlying cause of the bleeding. In patients with cirrhosis and active variceal bleeding, the current guidelines recommend against the use of TXA due to the lack of benefit and potential harm 1. Instead, standard therapy for variceal bleeding includes prompt initiation of vasoactive therapy, antibiotics, and endoscopic treatment.
Some key points to consider when managing GI bleeding include:
- The importance of prompt and appropriate treatment to reduce morbidity and mortality
- The need to identify and address the underlying cause of the bleeding
- The use of evidence-based guidelines to inform treatment decisions
- The potential risks and benefits of different treatments, including TXA
- The importance of monitoring patients for signs of thrombosis, especially those with pre-existing cardiovascular disease or other risk factors for clotting disorders.
In summary, the current evidence does not support the use of TXA as a first-line treatment for GI bleeding in patients with cirrhosis and active variceal bleeding, and its use should be avoided in this population due to the potential for harm 1.
From the Research
Effectiveness of Tranexamic Acid in GI Bleeding
- Tranexamic acid (TXA) has been shown to reduce the rates of continued bleeding, urgent endoscopic intervention, and mortality in patients with upper gastrointestinal bleeding 2.
- A double-blind randomized controlled trial found that early intravenous and/or intravenous plus topical administration of TXA reduces the need for urgent endoscopy for acute gastrointestinal bleeding 3.
- A systematic review and meta-analysis found that extended-use high-dose IV tranexamic acid does not improve mortality or bleeding outcomes and increases adverse events, while low-dose IV/enteral tranexamic acid may be effective in reducing hemorrhage 4.
Studies on Tranexamic Acid
- The Haemorrhage ALleviation with Tranexamic acid - Intestinal system (HALT-IT) trial aims to provide reliable evidence about the effects of TXA in acute upper and lower GI bleeding 5.
- A systematic review of randomized trials on tranexamic acid for upper gastrointestinal bleeding found that TXA may reduce all-cause mortality, but additional evidence is needed before treatment recommendations can be made 6.
Key Findings
- TXA can aid in changing an urgent endoscopy to an elective procedure, with better outcomes for both physicians and patients 3.
- The antifibrinolytic properties of TXA can help reduce bleeding in patients with gastrointestinal bleeding 2, 3.
- The effects of TXA on lower gastrointestinal bleeding warrant further clarification 2.