From the Guidelines
Tranexamic acid (TXA) should not be used to stop a GI bleed, particularly in patients with cirrhosis and active variceal bleeding, due to the lack of benefit and potential increased risk of venous thromboembolic events. The use of TXA in GI bleeding is still a topic of debate, with some studies suggesting a potential benefit in certain cases [ 1 ]. However, the most recent and highest quality study, a large randomized placebo-controlled trial, found no beneficial effect of TXA in patients with acute upper gastrointestinal bleeding, including those with suspected variceal bleeding and liver disease comorbidity [ 1 ]. In fact, the study found an almost 2-fold increase in the incidence of venous thromboembolic events in the TXA group compared to the placebo group.
Key Points to Consider
- The primary treatments for GI bleeding include endoscopic interventions, proton pump inhibitors (for upper GI bleeds), and addressing the underlying cause.
- TXA is not considered first-line therapy for most GI bleeds.
- The use of TXA should be guided by the specific cause and location of the bleeding.
- Patients with cirrhosis and active variceal bleeding should not receive TXA due to the lack of benefit and potential increased risk of venous thromboembolic events.
Potential Risks and Benefits
- The potential benefits of TXA in GI bleeding, such as reducing bleeding in certain cases, must be weighed against the potential risks, including an increased risk of venous thromboembolic events.
- The use of TXA should be individualized and based on the specific clinical scenario, taking into account the underlying cause of the bleeding and the patient's overall clinical condition.
From the Research
Effectiveness of TXA in GI Bleed
- TXA can reduce the rates of continued bleeding, urgent endoscopic intervention, and mortality in patients with upper gastrointestinal bleeding, as shown in a systematic review and meta-analysis of randomized controlled trials 2.
- However, the effects of TXA on lower gastrointestinal bleeding are less clear, with one study indicating no significant effect on blood transfusion requirements 3.
- A meta-analysis of randomized controlled trials found that extended-use high-dose IV TXA did not reduce mortality or bleeding outcomes, but increased adverse events, while low-dose IV/enteral TXA may be effective in reducing hemorrhage 4.
TXA in Upper GI Bleed
- TXA appears to have a beneficial effect on mortality in upper GI bleeding, but the evidence is not conclusive due to high dropout rates in some trials 5.
- A meta-analysis of randomized controlled trials found no significant difference in mortality, rebleeding, or need for surgery between TXA and placebo in upper GI bleeding, but found an increased risk of venous thromboembolic events with TXA 6.