From the Guidelines
Tranexamic Acid (TXA) can help stop gastrointestinal bleeding by inhibiting the breakdown of fibrin clots and promoting hemostasis. The use of TXA in acute gastrointestinal (GI) bleeding has been supported by several studies, including a guideline from the British Society of Gastroenterology 1, which suggests that TXA may be beneficial in reducing mortality from GI bleeding, although the evidence is not yet conclusive. A more recent study published in Critical Care in 2023 1 recommends the administration of TXA to trauma patients who are bleeding or at risk of significant bleeding, with a loading dose of 1 g infused over 10 minutes, followed by an intravenous infusion of 1 g over 8 hours.
- The optimal dosing of TXA for GI bleeding is not well established, but a dose of 1 g loading dose followed by 1 g over 8 hours is commonly recommended 1.
- The use of TXA in GI bleeding is generally considered safe, although there is a theoretical risk of thromboembolic events, which has not been well studied in this context 1.
- Other studies have suggested that TXA may be useful as a rescue therapy for patients with persistent bleeding from mucosal oozing or puncture wound bleeding consistent with impaired clot integrity 1.
- The AGA clinical practice update on coagulation in cirrhosis also recommends considering anti-fibrinolytic therapy, including TXA, in patients with persistent bleeding from mucosal oozing or puncture wound bleeding consistent with impaired clot integrity 1.
From the FDA Drug Label
Tranexamic Acid (TXA) and Gastrointestinal Bleeding
There is no direct information in the provided FDA Drug Label regarding the use of Tranexamic Acid (TXA) to stop gastrointestinal bleeding.
Reported Symptoms of Overdosage
The label does report symptoms of overdosage, which include gastrointestinal symptoms such as:
- Nausea
- Vomiting
- Diarrhea However, these symptoms do not provide information on the use of TXA to stop gastrointestinal bleeding 2.
Lack of Relevant Information
The provided FDA Drug Label does not contain relevant information to answer whether Tranexamic Acid (TXA) can stop gastrointestinal bleeding. There is no mention of its effectiveness in treating or stopping gastrointestinal bleeding 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 clinical scenarios, including gastrointestinal 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.
- 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 in patients with upper gastrointestinal bleeding 6.
- Another systematic review and individual patient data meta-analysis of 64,724 bleeding patients found that TXA reduced the odds of death by 16% and did not increase the odds of vascular occlusive events 7.
Mechanism of Action and Potential Benefits
- TXA inhibits the breakdown of fibrin clots by plasmin, which can help reduce bleeding and the need for blood transfusion 3, 5.
- The use of TXA as an adjuvant treatment during upper gastrointestinal bleeding may be beneficial, but thromboembolic risk and dosage should be carefully evaluated, especially in older patients with co-morbidities 5.
- Early administration of TXA may be worth recommending for treating upper gastrointestinal bleeding in the emergency department, but its effects on lower gastrointestinal bleeding require further clarification 6.
Clinical Implications and Future Directions
- The results of the HALT-IT trial and other studies suggest that TXA may be an effective medication for patients with upper gastrointestinal bleeding, but its effectiveness in lower gastrointestinal bleeding is still uncertain 3, 6, 7.
- Further research is needed to fully understand the benefits and risks of TXA in gastrointestinal bleeding and to determine the optimal dosage and timing of administration 3, 6, 7.