From the Guidelines
Tranexamic acid (TXA) may not be effective in stopping gastrointestinal bleeding, particularly in cases of variceal bleeding.
Key Findings
- A large randomized placebo-controlled trial including 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 1.
- The same trial found an almost 2-fold increase in the incidence of venous thromboembolic events in the TXA group compared to the placebo group, particularly in patients with comorbid liver disease/suspected variceal bleeding 1.
- The European Society of Intensive Care Medicine guidelines state that there is high certainty of harms with use of high-dose IV TXA and no clear benefit with its general use in gastrointestinal hemorrhage 1.
- The British Society of Gastroenterology guidelines suggest that the use of TXA in acute lower gastrointestinal bleeding should be confined to clinical trials, pending the results of the HALT-IT trial 1.
Important Considerations
- Dose and Administration: The effectiveness and safety of TXA may depend on the dose and route of administration, with low-dose/enteral TXA potentially being more beneficial than high-dose IV TXA 1.
- Patient Population: TXA may be more effective in certain patient populations, such as those with postpartum hemorrhage, but its use in gastrointestinal bleeding is less clear 1.
- Potential Harms: TXA may increase the risk of venous thromboembolic events, particularly in patients with comorbid liver disease/suspected variceal bleeding 1.
From the FDA Drug Label
Gastrointestinal Bleeding and Tranexamic Acid
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.
Mechanism of Action
TXA works by inhibiting the breakdown of fibrin clots, which are essential for stopping bleeding. However, the provided FDA Drug Label does not directly address the use of TXA for gastrointestinal bleeding.
Overdosage Symptoms
According to the FDA Drug Label 2, symptoms of TXA overdosage may include gastrointestinal issues such as:
- Nausea
- Vomiting
- Diarrhea
These symptoms suggest that while TXA may be associated with gastrointestinal side effects, the label does not provide information on its use for stopping gastrointestinal bleeding. There is no direct evidence from the provided FDA Drug Label to support the use of TXA for this specific condition 2.
From the Research
Effectiveness of Tranexamic Acid in Gastrointestinal Bleeding
- Tranexamic acid (TXA) has been studied for its potential to stop gastrointestinal bleeding, with some evidence suggesting it may be effective in reducing bleeding and mortality 3, 4, 5, 6, 7.
- The HALT-IT trial, a large international randomized controlled trial, aimed to provide reliable evidence on the effects of TXA in acute upper and lower GI bleeding 3.
- A systematic review and meta-analysis of randomized clinical trials found that TXA significantly reduced the rates of continued bleeding, urgent endoscopic intervention, and mortality compared to placebo 7.
- Another systematic review suggested that TXA may reduce all-cause mortality and rebleeding in patients with upper gastrointestinal bleeding, without increasing thromboembolic adverse effects 5.
Mechanism of Action and Potential Benefits
- TXA works by inhibiting the breakdown of fibrin clots by plasmin, which can help reduce bleeding and the need for blood transfusion 3.
- The use of TXA as an adjuvant treatment during upper gastrointestinal bleeding may be appropriate, but careful evaluation of thromboembolic risk and dosage is necessary, especially in older patients with co-morbidities 6.
Limitations and Future Directions
- While the available evidence suggests that TXA may be effective in reducing bleeding and mortality in gastrointestinal bleeding, further clarification is needed on its effects in lower gastrointestinal bleeding 7.
- The HALT-IT trial and other studies have methodological limitations and small sample sizes, which can affect the internal and external validity of the results 3, 4.