From the Guidelines
Tranexamic acid (TXA) may help stop a gastrointestinal (GI) bleed, but its use is currently recommended to be confined to clinical trials. The evidence from studies such as the one published in Gut 1 suggests that TXA can improve mortality from trauma and has some benefit in acute GI bleeding, with a 40% risk reduction in mortality. However, this treatment benefit was no longer apparent when the analysis was limited to trials at low risk of bias.
- The recommended dose of TXA is a loading dose of 1 g infused over 10 min, followed by an i.v. infusion of 1 g over 8 h, as suggested by the European guideline on management of major bleeding and coagulopathy following trauma 1.
- The use of TXA in acute lower gastrointestinal bleeding (LGIB) is still uncertain and more research is needed to determine its effectiveness, as stated in the guidelines from the British Society of Gastroenterology 1.
- Other studies, such as the CRASH-2 trial, have shown that early administration of TXA can reduce the risk of death due to bleeding in trauma patients 1.
- However, the European Society of Intensive Care Medicine recommends that the use of high-dose IV TXA in gastrointestinal hemorrhage should be avoided due to high certainty of harms and no clear benefit 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 Dosage
- The thromboembolic risk and TXA dosage should be carefully evaluated, especially in older patients with co-morbidities 6.
- Data from included trials suggested that TXA did not significantly increase the risk of thromboembolic disease 2.