Can tranexamic acid (TXA) stop a gastrointestinal (GI) bleed?

Can TXA Stop a GI Bleed?

Tranexamic acid (TXA) should not be used to stop a gastrointestinal (GI) bleed due to lack of benefit and increased risk of thromboembolic events. 1, 2

Evidence and Recommendations

• Guideline Insights:

  • The British Society of Gastroenterology suggests that the use of TXA in acute lower GI bleeding should be confined to clinical trials, pending further evidence 3.
  • The American College of Gastroenterology does not recommend high-dose IV TXA for GI bleeding due to lack of benefit and increased thrombotic risk 1.

• Research Findings:

  • The HALT-IT trial, a large international study, found no reduction in mortality or rebleeding rates with high-dose IV TXA in GI bleeding, and noted an increased risk of thromboembolic events 2.
  • A systematic review and meta-analysis confirmed that high-dose IV TXA does not improve outcomes in GI bleeding and increases adverse events such as deep venous thrombosis and pulmonary embolism 4.
  • Low-dose IV or enteral TXA may reduce rebleeding and the need for surgical intervention, but more evidence is needed to confirm its safety and efficacy 1, 4.

Clinical Approach

• Standard Management:

  • Prioritize resuscitation, endoscopic therapy, and pharmacological treatments for GI bleeding 1.
  • Avoid the use of high-dose IV TXA due to the lack of benefit and increased risk of thromboembolic events 1, 2.

• Special Considerations:

  • TXA should not be used in patients with cirrhosis and active variceal bleeding due to increased thrombotic risk 1.
  • For variceal bleeding, standard therapy with vasoactive drugs, antibiotics, and endoscopic band ligation should be used instead of TXA 1.

Common Pitfalls and Caveats

• Extrapolation from Other Conditions:

  • While TXA is effective in reducing bleeding in trauma and surgical settings, this does not translate to GI bleeding, emphasizing the need for disease-specific evidence 1.

• Thromboembolic Risks:

  • Be aware of the increased risk of thromboembolic events with high-dose TXA, which outweighs any potential benefits in GI bleeding 2.

In summary, the current evidence strongly advises against the use of TXA for GI bleeding outside of clinical trials, due to the lack of demonstrated benefit and increased risk of adverse events.