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 variceal bleeding and may even increase the risk of venous thromboembolic events 1.
Key Points
- 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 1.
- The use of TXA in GI bleeding is not supported by strong evidence, and its potential benefits are outweighed by the risks of thrombotic events, particularly in patients with comorbid liver disease or suspected variceal bleeding 1.
- Other treatments, such as endoscopic therapy, portal hypertension-lowering drugs, and blood product replacement, are preferred for managing GI bleeding, especially in patients with cirrhosis 1.
Clinical Considerations
- The decision to use TXA in GI bleeding should be made on a case-by-case basis, taking into account the individual patient's risk factors and the potential benefits and risks of treatment 1.
- Patients with a history of thromboembolism should be cautioned against the use of TXA, as it may increase the risk of recurrent thrombotic events 1.
- The use of viscoelastic tests, such as thromboelastography, may be helpful in guiding transfusion therapy in patients with GI bleeding, but its role in TXA administration is unclear 1.