From the Guidelines
Tranexamic Acid (TXA) is not recommended to stop a gastrointestinal (GI) bleed, as the current evidence suggests it may not be effective in this context and could potentially increase the risk of thromboembolic events.
- The study by 1 found that TXA had no beneficial effect in patients with acute upper gastrointestinal bleeding, including those with suspected variceal bleeding and liver disease comorbidity.
- Additionally, the study by 1 reported an almost 2-fold increase in the incidence of venous thromboembolic events in the TXA group compared to the placebo group, particularly in patients with comorbid liver disease/suspected variceal bleeding.
- In contrast, the study by 1 suggested that TXA may have a benefit in acute GI bleeding, with a 40% risk reduction in mortality, but this benefit was no longer apparent when the analysis was limited to trials at low risk of bias.
- The European guideline on management of major bleeding and coagulopathy following trauma, as reported by 1 and 1, recommends the use of TXA in trauma patients who are bleeding or at risk of significant bleeding, but this may not be directly applicable to GI bleeding.
- Other studies, such as 1, suggest that TXA may be considered as a rescue therapy in patients with persistent bleeding consistent with impaired clot integrity, but this is not a primary recommendation for GI bleeding.
The FDA Drug Labels for tranexamic acid (PO) do not address this question.
From the Research
Effectiveness of Tranexamic Acid in GI Bleeding
- The effectiveness of Tranexamic Acid (TXA) in stopping a gastrointestinal (GI) bleed is a topic of ongoing research, with studies yielding mixed results 2, 3, 4, 5, 6.
- Some studies suggest that TXA may reduce the risk of death due to bleeding in patients with upper GI bleeding 4, 5, while others have found no significant effect on blood transfusion requirements in patients with lower GI bleeding 3.
Upper GI Bleeding
- 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 GI bleeding 5.
- Another study found that TXA may reduce all-cause mortality in patients with upper GI bleeding, although the evidence was limited by the small size and methodological weaknesses of the included trials 4.
Lower GI Bleeding
- A double-blind prospective randomized controlled trial found that intravenous TXA had no significant effect on blood transfusion requirements in patients with lower GI bleeding 3.
- However, the evidence on the effects of TXA in lower GI bleeding is limited, and further research is needed to fully understand its potential benefits and risks.
Overall Effectiveness
- 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% across different bleeding conditions, including GI bleeding 6.
- The results of this study suggest that the effectiveness of TXA in GI bleeding should be considered in the context of other relevant evidence, and that a reduction in the risk of death cannot be discounted 6.