From the Guidelines
Tranexamic acid (TXA) may not be effective in stopping a gastrointestinal (GI) bleed, as evidenced by a large randomized placebo-controlled trial including 12,009 patients with acute upper gastrointestinal bleeding, which showed no beneficial effect of TXA in reducing mortality due to bleeding 1.
Key Points
- The use of TXA in acute GI bleeding has been evaluated in several trials, but the results are inconsistent and often limited by high risk of bias or small sample sizes 1.
- A recent study found that TXA was not effective in reducing mortality or rebleeding in patients with variceal bleeding, and may even increase the risk of venous thromboembolic events 1.
- The European Society of Intensive Care Medicine recommends against the use of high-dose IV TXA in critically ill patients with gastrointestinal bleeding, citing high certainty of harms and no clear benefit 1.
- However, some studies suggest that low-dose or enteral TXA may be helpful in certain cases, such as mucosal oozing or puncture wound bleeding, although the evidence is limited and more research is needed 1.
Dosage and Administration
- The optimal dosage and administration of TXA for GI bleeding is unclear, but high-dose IV TXA is not recommended due to the risk of harms 1.
- Low-dose or enteral TXA may be considered in certain cases, but more research is needed to determine the optimal dosage and administration regimen.
From the FDA Drug Label
Tranexamic Acid (TXA) and Gastrointestinal (GI) Bleed
The provided FDA Drug Label for tranexamic acid (TXA) does not directly address its use in stopping a gastrointestinal (GI) bleed [ 2 ].
Overdose Symptoms
According to the label, overdose symptoms of TXA may include gastrointestinal issues such as:
- Nausea
- Vomiting
- Diarrhea However, this information does not provide insight into the drug's effectiveness in stopping a GI bleed.
Treatment of Overdose
The label states that no specific information is available on the treatment of overdose with tranexamic acid [ 2 ]. In the event of an overdose, the recommended course of action is to employ usual supportive measures, such as clinical monitoring and supportive therapy, as dictated by the patient's clinical status.
There are no research papers provided to assist in answering whether TXA can stop a GI bleed.
From the Research
Effectiveness of Tranexamic Acid in GI Bleeding
- Tranexamic acid (TXA) has been studied for its potential to reduce bleeding and mortality in patients with gastrointestinal (GI) bleeding 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.
- Meta-analyses of randomized controlled trials have suggested that TXA may reduce rebleeding, mortality, and the need for urgent endoscopic intervention in patients with upper GI bleeding 4, 5, 6.
Reduction in Mortality and Bleeding
- A systematic review and meta-analysis of individual patient data from 64,724 bleeding patients found that TXA reduced the odds of death by 16% (OR=0.84,95% CI: 0.78 to 0.91, p<0.0001) 7.
- Another study found that TXA significantly reduced the rates of continued bleeding (RR = 0.60; 95%CI, 0.43-0.84), urgent endoscopic intervention (RR = 0.35; 95%CI, 0.24-0.50), and mortality (RR = 0.60; 95%CI, 0.45-0.80) compared with the placebo 6.
Safety and Adverse Effects
- The available evidence suggests that TXA does not increase the risk of thromboembolic adverse effects in patients with upper GI bleeding 4, 5, 7.
- A systematic review and meta-analysis found that TXA did not increase the odds of vascular occlusive events (VOEs) (0.94,0.81 to 1.08, p for effect=0.36) 7.
Clinical Implications
- The results of the studies suggest that TXA may be an effective medication for patients with upper GI bleeding, and early administration of TXA may be worth recommending for treating upper GI bleeding in the emergency department 6.
- However, the effects of TXA on lower GI bleeding warrant further clarification 6.