From the Guidelines
Tranexamic Acid (TXA) can help stop a Gastrointestinal (GI) bleed, but its effectiveness depends on the specific context and patient population. In the context of acute lower gastrointestinal bleeding, TXA has shown a 40% risk reduction in mortality 1. However, this benefit was not apparent when the analysis was limited to trials at low risk of bias, and the studies were considered historic, making it uncertain how well the results extrapolate to modern day care.
- The optimal dosing of TXA is a loading dose of 1 g infused over 10 minutes, followed by an intravenous infusion of 1 g over 8 hours 1.
- The use of TXA in acute GI bleeding is still being studied, and some guidelines suggest that its use be confined to clinical trials, pending the results of the HALT-IT trial 1.
- In patients with cirrhosis and active variceal bleeding, TXA should not be used, as it has not shown a beneficial effect and may increase the risk of venous thromboembolic events 1.
- In other contexts, such as mucosal oozing or puncture wound bleeding, anti-fibrinolytic therapy with TXA may be considered 1.
The FDA Drug Labels for tranexamic acid (PO) do not address this question.
From the Research
Effectiveness of Tranexamic Acid in GI Bleeding
- Tranexamic acid (TXA) may be effective in reducing upper gastrointestinal bleeding and stabilizing patients before endoscopic treatments 2.
- A systematic review of randomized trials on TXA for upper gastrointestinal bleeding suggested that TXA may reduce all-cause mortality, but additional evidence is needed due to limitations in the internal and external validity of included trials 2.
- Another study found that TXA probably decreases rebleeding and mortality, without increasing thromboembolic adverse effects in patients with upper gastrointestinal bleeding 3.
- A systematic review with meta-analysis of randomized clinical trials found that TXA significantly reduced the rates of continued bleeding, urgent endoscopic intervention, and mortality compared with the placebo in patients with upper gastrointestinal bleeding 4.
Mechanism of Action
- TXA reduces bleeding by inhibiting the breakdown of fibrin clots by plasmin 5.
- TXA inhibits the degradation of a newly formed fibrin clot, reducing blood loss and transfusion requirements in various clinical scenarios 6.
Safety and Recommendations
- The use of TXA in patients with gastrointestinal bleeding is not part of standard treatment, and thromboembolic risk and TXA dosage should be carefully evaluated, especially in older patients with co-morbidities 6.
- Early administration of TXA may be worth recommending for treating upper gastrointestinal bleeding in the emergency department, but the effects of TXA on lower gastrointestinal bleeding warrant further clarification 4.