Does tranexamic acid (TXA) stop gastrointestinal bleeding?

From the Guidelines

Tranexamic acid (TXA) is not recommended for stopping gastrointestinal bleeding, particularly in patients with cirrhosis and variceal bleeding, as it has been shown to have no beneficial effect in reducing mortality due to GI bleeding and may even increase the risk of venous thromboembolic events 1.

Key Points

• The use of TXA in patients with cirrhosis and active variceal bleeding is strongly discouraged due to the lack of benefit and potential harm 1.
• A large randomized placebo-controlled trial of 12,009 patients with acute upper gastrointestinal bleeding found no beneficial effect of TXA in reducing mortality due to GI bleeding, and an increased risk of venous thromboembolic events 1.
• The European Society of Intensive Care Medicine suggests not using high-dose IV TXA in critically ill patients with gastrointestinal bleeding due to high certainty of harms and no clear benefit 1.
• The British Society of Gastroenterology recommends that the use of TXA in acute lower gastrointestinal bleeding be confined to clinical trials, pending the results of further studies 1.

Dosage and Administration

• The optimal dosage and administration of TXA for gastrointestinal bleeding is unclear, but high-dose IV TXA is not recommended due to potential harms 1.
• Low-dose or enteral TXA may be considered in specific cases, but the evidence is limited and more research is needed to determine its effectiveness and safety 1.

From the FDA Drug Label

Tranexamic Acid (TXA) and Gastrointestinal Bleeding

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

Adverse Effects

However, it does mention that gastrointestinal symptoms such as nausea, vomiting, and diarrhea can occur as a result of overdosage [ 2 ]. The label lists the following potential symptoms of overdosage:

• Gastrointestinal: nausea, vomiting, diarrhea
• Hypotensive: orthostatic symptoms
• Thromboembolic: arterial, venous, embolic
• Neurologic: visual impairment, convulsions, headache, mental status changes
• Myoclonus
• Rash

Relevance to Gastrointestinal Bleeding

There is no information in the provided Drug Label that suggests tranexamic acid is used to stop gastrointestinal bleeding [ 2 ]. Therefore, based on this label, it cannot be determined if TXA is effective in stopping gastrointestinal bleeding.

From the Research

Effectiveness of Tranexamic Acid in Gastrointestinal Bleeding

• Tranexamic acid (TXA) has been studied for its effectiveness in stopping gastrointestinal bleeding, with some studies suggesting it may reduce mortality and rebleeding rates 3, 4, 5.
• A 2022 population-based cohort study found that early TXA administration was associated with a reduced risk of mortality in patients with gastrointestinal bleeding, without an increase in thromboembolic events 3.
• A 2015 systematic review and meta-analysis found that TXA probably decreases rebleeding and mortality in patients with upper gastrointestinal bleeding, without increasing thromboembolic adverse effects 4.
• Another systematic review and meta-analysis published in 2021 found that TXA significantly reduced the rates of continued bleeding, urgent endoscopic intervention, and mortality in patients with upper gastrointestinal bleeding 5.

Safety and Potential Risks

• The studies found no significant increase in thromboembolic events with TXA treatment 3, 4, 6, 7.
• However, the evidence is not conclusive, and some studies suggest that TXA may not be effective in all cases of gastrointestinal bleeding, particularly in lower gastrointestinal bleeding 5.
• The quality of the evidence is limited by the heterogeneity of the studies and the lack of high-quality randomized controlled trials 6, 7.

Clinical Implications

• The available evidence suggests that TXA may be an effective medication for patients with upper gastrointestinal bleeding, particularly when administered early 3, 5.
• However, further randomized clinical trials are needed to confirm the effectiveness and safety of TXA in gastrointestinal bleeding, particularly in combination with other treatments such as endoscopic therapy 3, 6.