From the Guidelines
Tranexamic Acid (TXA) in Gastrointestinal (GI) Bleeding
TXA Mechanism and Use: Tranexamic acid (TXA) is an antifibrinolytic agent that inhibits the breakdown of blood clots, allowing them to form and stabilize, which can help control bleeding. In the context of a GI bleed, TXA can help promote hemostasis by reducing the dissolution of clots that have formed over the bleeding site, thereby reducing or stopping the bleeding.
Efficacy of TXA in GI Bleeding
- A study published in Gut 1 found that TXA improves mortality from trauma when given intravenously in the acute setting and has been incorporated into massive transfusion protocols in many hospitals. However, its benefit in acute GI bleeding is less clear, with some evidence suggesting a 40% risk reduction in mortality, although this benefit was not apparent in trials at low risk of bias.
- The CRASH-2 trial 1 demonstrated that early administration of TXA in trauma patients reduced the risk of death due to bleeding, with a recommended dose of 1g infused over 10 minutes, followed by an intravenous infusion of 1g over 8 hours.
- However, guidelines from the European Association for the Study of the Liver (EASL) 1 recommend against the use of TXA in patients with cirrhosis and active variceal bleeding, citing a lack of benefit and potential increased risk of thromboembolic events.
- The European guideline on management of major bleeding and coagulopathy following trauma 1 recommends the use of TXA in trauma patients who are bleeding or at risk of significant bleeding, as soon as possible and within 3 hours after injury.
Key Points
- TXA may be beneficial in reducing mortality in trauma patients, but its efficacy in GI bleeding is less clear.
- The recommended dose of TXA is 1g infused over 10 minutes, followed by an intravenous infusion of 1g over 8 hours.
- TXA is not recommended for use in patients with cirrhosis and active variceal bleeding due to lack of benefit and potential increased risk of thromboembolic events.
- The decision to use TXA in GI bleeding should be made on a case-by-case basis, considering the underlying cause of the bleed and the patient's individual risk factors.
From the FDA Drug Label
Tranexamic Acid (TXA) and Gastrointestinal (GI) Bleeding
Overview of TXA
Tranexamic acid (TXA) is used for various medical conditions, but its primary use is to prevent or treat excessive blood loss from major trauma, postpartum bleeding, surgery, tooth removal, nosebleeds, and heavy menstruation 2.
Potential Side Effects of TXA
- Gastrointestinal symptoms such as nausea, vomiting, and diarrhea have been reported in cases of TXA overdosage 2.
- There is no direct information in the provided FDA Drug Label about TXA stopping gastrointestinal (GI) bleeding.
GI Bleeding and TXA
Since the provided information does not directly address the use of TXA for stopping GI bleeding, it is essential to consult other relevant sources for a comprehensive understanding of TXA's effects on GI bleeding 2.
| Symptom | Description |
|---|---|
| Nausea | Reported in cases of TXA overdosage |
| Vomiting | Reported in cases of TXA overdosage |
| Diarrhea | Reported in cases of TXA overdosage |
From the Research
Tranexamic Acid (TXA) and Gastrointestinal (GI) Bleeding
- The use of tranexamic acid (TXA) in patients with gastrointestinal (GI) bleeding has been studied in several trials, with varying results 3, 4, 5, 6, 7.
- A randomized controlled trial published in The Lancet in 2020 found that TXA did not reduce death from GI bleeding 3.
- However, a systematic review and meta-analysis published in Alimentary Pharmacology & Therapeutics in 2020 found that TXA was associated with a significant reduction in mortality in patients with upper GI bleeding 4.
- Another study published in the Journal of Clinical Medicine in 2022 found that early TXA treatment was associated with a reduced risk of mortality in patients with GI bleeding, without an increase in thromboembolic events 5.
- A systematic review and meta-analysis published in The American Journal of Emergency Medicine in 2021 found that TXA significantly reduced the rates of continued bleeding, urgent endoscopic intervention, and mortality in patients with GI bleeding 6.
- A more recent systematic review and individual patient data meta-analysis published in BMJ Open in 2023 found that TXA reduced the odds of death by 16% in patients with GI bleeding, and that there was no evidence for heterogeneity between trials assessing the effect of TXA on death or vascular occlusive events 7.
Key Findings
- TXA may be effective in reducing mortality in patients with upper GI bleeding 4, 6.
- Early TXA treatment may be associated with a reduced risk of mortality in patients with GI bleeding 5.
- TXA may not increase the risk of thromboembolic events in patients with GI bleeding 5, 7.
- The evidence for the use of TXA in GI bleeding is not consistent, and further studies are needed to fully understand its effects 3, 7.