Does tranexamic acid (TXA) stop gastrointestinal bleeding?

From the Guidelines

Tranexamic Acid (TXA) in Gastrointestinal Bleeding

TXA Mechanism and Efficacy: Tranexamic acid (TXA) is an antifibrinolytic agent that works by inhibiting the breakdown of fibrin clots, which can help stabilize clots that have formed at the site of bleeding. By preventing the dissolution of these clots, TXA can help control bleeding, including gastrointestinal bleeding.

Evidence for TXA Use 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 trials showing 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 to trauma patients who are bleeding or at risk of significant bleeding reduces all-cause mortality and the risk of death due to bleeding. The recommended dose is a loading dose of 1 g infused over 10 minutes, followed by an intravenous infusion of 1 g over 8 hours.
• However, guidelines from the Journal of Hepatology 1 recommend against the use of TXA in patients with cirrhosis and active variceal bleeding, citing a lack of beneficial effect and an increased risk of venous thromboembolic events.
• More recent guidelines from Critical Care 1 continue to recommend 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 effective in reducing mortality due to GI bleeding in certain contexts, such as trauma.
• The recommended dose of TXA is a loading dose of 1 g infused over 10 minutes, followed by an intravenous infusion of 1 g over 8 hours.
• TXA is not recommended for use in patients with cirrhosis and active variceal bleeding due to a lack of beneficial effect and increased risk of thromboembolic events.
• Further studies are needed to fully understand the role of TXA in GI bleeding and to determine its potential benefits and risks in different patient populations.

From the FDA Drug Label

Tranexamic Acid (TXA) and Gastrointestinal Bleeding

Efficacy of TXA in Stopping Gastrointestinal Bleeding

The provided FDA Drug Label for tranexamic acid (TXA) does not directly address its efficacy in stopping gastrointestinal bleeding [ 2 ].

• The label discusses symptoms of overdosage, which include gastrointestinal issues such as nausea, vomiting, and diarrhea.
• There is no mention of TXA's effectiveness in treating or stopping gastrointestinal bleeding.

Available Information

Given the information provided in the FDA Drug Label for tranexamic acid (TXA) [ 2 ], there is no direct evidence to support its use in stopping gastrointestinal bleeding.

• The label focuses on the symptoms of overdosage rather than the drug's therapeutic effects on gastrointestinal bleeding.
• Without further information or studies specifically addressing the use of TXA in gastrointestinal bleeding, its efficacy in this context cannot be determined from the provided data.

From the Research

Efficacy of Tranexamic Acid in Gastrointestinal Bleeding

• The use of tranexamic acid (TXA) in gastrointestinal bleeding has been studied in several trials, with mixed results 3, 4, 5, 6, 7.
• A large randomized controlled trial (HALT-IT) found that TXA did not reduce death from gastrointestinal bleeding, and may even increase the risk of venous thromboembolic events and seizures 3, 4.
• A systematic review and meta-analysis of 14 RCTs found that TXA did not reduce mortality in patients with acute upper or lower gastrointestinal bleeding, and may confer an increased risk of seizures 5.
• However, another systematic review and meta-analysis found that TXA was associated with a significant reduction in mortality in patients with upper gastrointestinal bleeding, although the quality of the evidence was rated as moderate due to risk of bias 6.
• A more recent systematic review and meta-analysis found that extended-use high-dose IV TXA did not reduce mortality or bleeding outcomes, but may increase adverse events such as deep venous thrombosis, pulmonary embolism, and seizure 7.

Safety and Adverse Events

• The use of TXA in gastrointestinal bleeding has been associated with an increased risk of venous thromboembolic events, such as deep vein thrombosis and pulmonary embolism 3, 4, 7.
• Seizures have also been reported as a potential adverse event associated with TXA use in gastrointestinal bleeding 4, 5, 7.
• The risk of arterial thromboembolic events, such as myocardial infarction or stroke, was found to be similar between TXA and placebo groups in some studies 3, 4.

Clinical Implications

• The current evidence suggests that TXA may not be effective in reducing mortality or bleeding outcomes in patients with gastrointestinal bleeding, and may even increase the risk of adverse events 3, 4, 5, 7.
• However, some studies suggest that TXA may be beneficial in reducing mortality in patients with upper gastrointestinal bleeding, although the quality of the evidence is limited 6.
• Further research is needed to fully understand the efficacy and safety of TXA in gastrointestinal bleeding, and to determine the optimal dosing strategy and patient population for its use.