From the Guidelines
Tranexamic Acid (TXA) is not recommended as a primary treatment to stop gastrointestinal bleeding, as the current evidence suggests it may not be effective in this context.
- In the context of acute lower gastrointestinal bleeding, TXA may have some benefit, with a 40% risk reduction in mortality observed in pooled analysis of several trials 1. However, this treatment benefit was no longer apparent when the analysis was limited to trials at low risk of bias.
- A large randomized placebo-controlled trial of 12,009 patients with acute upper gastrointestinal bleeding found no beneficial effect of TXA in reducing death due to bleeding within the first 5 days, and actually observed an increased incidence of venous thromboembolic events in the TXA group 1.
- The use of TXA is not recommended in patients with cirrhosis and active variceal bleeding, as it may increase the risk of thromboembolic events and has not been shown to have a net clinical benefit in this setting 1.
- TXA may be considered for patients with hereditary hemorrhagic telangiectasia (HHT) and mild gastrointestinal bleeding, due to its low potential for harm, although the evidence for its effectiveness is limited 1.
- The decision to use TXA in gastrointestinal bleeding should be made on a case-by-case basis, taking into account the underlying cause of the bleeding, the severity of the bleeding, and the patient's individual risk factors for thromboembolic events.
From the FDA Drug Label
Gastrointestinal Bleeding and Tranexamic Acid
The provided FDA Drug Label for tranexamic acid (TXA) does not directly address its effectiveness in stopping gastrointestinal bleeding [ 2 ].
Overdose Symptoms
However, it does mention that overdose symptoms may include gastrointestinal issues such as:
- Nausea
- Vomiting
- Diarrhea
These symptoms suggest that tranexamic acid may affect the gastrointestinal system, but there is no information on its use in stopping gastrointestinal bleeding [ 2 ].
Treatment of Overdose
In the event of an overdose, the label recommends employing usual supportive measures, such as clinical monitoring and supportive therapy, as dictated by the patient's clinical status [ 2 ].
There is no specific information available on the treatment of gastrointestinal bleeding with tranexamic acid in the provided Drug Label [ 2 ].
From the Research
Effectiveness of Tranexamic Acid in Gastrointestinal Bleeding
- Tranexamic acid (TXA) has been studied for its potential to reduce bleeding in various medical conditions, including gastrointestinal bleeding 3, 4.
- A double-blind prospective randomized controlled trial published in the World Journal of Surgery found that intravenous TXA had no significant effect on blood requirement in patients with lower GI bleeding 3.
- The study enrolled 81 patients with lower GI hemorrhage and randomly assigned them to receive intravenous TXA or placebo, with no difference in the consumption of packed red blood cells (PRBC) units among the patients in the placebo and TXA groups 3.
Systematic Review and Meta-Analysis
- A systematic review and meta-analysis published in the Irish Journal of Medical Science assessed the use of TXA in acute gastrointestinal bleeding, including both upper and lower GI bleeding 4.
- The review included 14 randomized controlled trials with 14,338 patients and found no significant difference in mortality between TXA and placebo 4.
- The secondary outcomes, including rebleeding, need for surgical intervention, endoscopic intervention, transfusion requirement, and length of stay, did not yield significant results 4.
- The review also found that TXA may confer an increased risk of seizures, with one trial reporting an increased risk of seizure in the TXA group 4.
Key Findings
- The current evidence suggests that TXA does not reduce mortality in patients with acute upper or lower gastrointestinal bleeding 4.
- TXA also does not appear to have a significant effect on transfusion requirements in patients with lower GI bleeding 3.
- The use of TXA in acute gastrointestinal bleeding may not be recommended due to the lack of significant benefits and potential increased risk of seizures 4.