From the Guidelines
Tranexamic acid (TXA) should not be used to stop an upper gastrointestinal (GI) bleed, particularly 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 1. When considering the management of upper GI bleeding, it is essential to prioritize evidence-based treatments that have been proven to reduce morbidity, mortality, and improve quality of life.
- The mainstay treatments for upper GI bleeds include proton pump inhibitors, endoscopic intervention, and correction of coagulopathy.
- TXA has been evaluated in a large randomized placebo-controlled trial, which found no beneficial effect in patients with acute upper gastrointestinal bleeding, including those with suspected variceal bleeding and liver disease comorbidity 1.
- The use of TXA in this context may even be harmful, as it has been associated with an increased risk of venous thromboembolic events, particularly in patients with comorbid liver disease or suspected variceal bleeding 1.
- Therefore, TXA should not be considered a first-line therapy for upper GI bleeding, and its use should be avoided in patients with cirrhosis and active variceal bleeding.
- Instead, healthcare providers should focus on evidence-based treatments that have been proven to improve outcomes in patients with upper GI bleeding, such as prompt initiation of vasoactive therapy, antibiotics, and endoscopic treatment 1.
From the Research
Effectiveness of Tranexamic Acid in Upper GI Bleed
- The use of tranexamic acid (TXA) in upper gastrointestinal (GI) bleeding has been studied in several trials, with mixed results 2, 3, 4, 5, 6.
- A systematic review published in 2008 found that TXA may reduce all-cause mortality in patients with upper GI bleeding, but the evidence was limited by the quality of the included trials 2.
- A more recent systematic review and meta-analysis published in 2021 found that TXA significantly reduced the rates of continued bleeding, urgent endoscopic intervention, and mortality in patients with upper GI bleeding 4.
- However, another study published in 2021 found no significant positive effect of TXA in patients with upper GI bleeding, and suggested that TXA may not be effective in this setting 3.
- A large randomized controlled trial published in 2021 found that TXA did not reduce death from gastrointestinal bleeding, and was not cost-effective in adults with acute gastrointestinal bleeding 6.
Safety and Adverse Effects
- The safety profile of TXA in upper GI bleeding has been evaluated in several studies, with some reports of thromboembolic events and seizures 5, 6.
- A study published in 2021 found that TXA was associated with a higher risk of venous thromboembolic events, but not arterial thromboembolic events 6.
- Another study published in 2012 found that TXA was not associated with an increased risk of thromboembolic events, but the number of events was small 5.