Can Tranexamic Acid (TXA) stop gastrointestinal bleeding?

From the Guidelines

Tranexamic Acid (TXA) is not recommended as a routine treatment to stop gastrointestinal bleeding, particularly in patients with cirrhosis and variceal bleeding, as it has been shown to have no beneficial effect on mortality and may even increase the risk of venous thromboembolic events 1.

Mechanism of Action

TXA is an antifibrinolytic agent that works by inhibiting the breakdown of fibrin clots, which can help stabilize clots that have formed in the gastrointestinal tract and stop bleeding.

Efficacy in GI Bleeding

However, the evidence suggests that TXA may not be effective in stopping gastrointestinal bleeding, especially in cases of variceal bleeding. A large randomized placebo-controlled trial including 12,009 patients with acute upper gastrointestinal bleeding found no beneficial effect of TXA on mortality, and even reported an increased incidence of venous thromboembolic events in the TXA group 1.

Specific Patient Populations

In patients with cirrhosis and active variceal bleeding, the use of TXA is strongly discouraged due to the lack of benefit and potential harm 1. In cases of non-variceal bleeding, the evidence is limited, and TXA should not be used as a routine treatment 1.

Clinical Guidelines

The European Society of Intensive Care Medicine and the British Society of Gastroenterology recommend against the routine use of TXA in gastrointestinal hemorrhage, citing the lack of clear benefit and potential harms 1. The EASL clinical practice guidelines also discourage the use of TXA in patients with cirrhosis and active variceal bleeding, and recommend a case-by-case approach for patients with non-variceal bleeding 1.

Dosage and Administration

There is no recommended dosage of TXA for the treatment of gastrointestinal bleeding, as its use is not supported by the evidence. However, in cases where TXA is considered, the dosage should be carefully evaluated to minimize the risk of adverse effects.

Adverse Effects

The use of TXA has been associated with an increased risk of venous thromboembolic events, particularly in patients with cirrhosis and variceal bleeding 1. Other potential adverse effects of TXA include seizures and renal impairment.

Alternative Treatments

The management of gastrointestinal bleeding should be tailored to the individual patient, taking into account the underlying cause and severity of the bleed. Alternative treatments, such as endoscopic therapy, portal hypertension-lowering drugs, and blood transfusions, may be more effective in stopping gastrointestinal bleeding and improving patient outcomes 1.

From the FDA Drug Label

Gastrointestinal Bleeding and Tranexamic Acid

The provided FDA Drug Label for tranexamic acid (TXA) does not directly address its effectiveness in stopping gastrointestinal bleeding [ 2 ].

Adverse Effects

However, it does mention that gastrointestinal symptoms such as nausea, vomiting, and diarrhea can occur as a result of overdosage [ 2 ]. The label lists the following potential symptoms of overdosage:

• Gastrointestinal: nausea, vomiting, diarrhea
• Hypotensive: orthostatic symptoms
• Thromboembolic: arterial, venous, embolic
• Neurologic: visual impairment, convulsions, headache, mental status changes
• Myoclonus
• Rash

There is no information in the provided label to suggest that tranexamic acid can stop gastrointestinal bleeding.

From the Research

Effectiveness of Tranexamic Acid in Gastrointestinal Bleeding

• The use of tranexamic acid (TXA) in acute gastrointestinal bleeding has been studied in several trials, with mixed results 3, 4, 5, 6, 7.
• A 2015 study found that TXA probably decreases rebleeding and mortality in patients with upper gastrointestinal bleeding, without increasing thromboembolic adverse effects 3.
• A 2019 trial aimed to provide reliable evidence about the effects of TXA in acute upper and lower GI bleeding, but the results are not yet available 4.
• A 2024 systematic review and meta-analysis found that TXA does not reduce mortality in patients with acute upper or lower gastrointestinal bleeding and may confer an increased risk of seizures 5.
• A 2008 systematic review suggested that TXA may reduce all-cause mortality in upper gastrointestinal bleeding, but additional evidence is needed before treatment recommendations can be made 6.
• A 2020 randomized controlled trial found that locally administered TXA confers no additional benefit over standard care in patients with upper gastrointestinal hemorrhage 7.

Safety of Tranexamic Acid in Gastrointestinal Bleeding

• The safety of TXA in gastrointestinal bleeding has been evaluated in several studies, with most finding no increased risk of thromboembolic events 3, 5, 6, 7.
• However, one trial reported an increased risk of seizure in the TXA group 5.
• Another study found that TXA did not significantly increase the risk of thromboembolic disease 6.

Clinical Implications

• The evidence suggests that TXA may not be effective in reducing mortality or rebleeding in patients with acute gastrointestinal bleeding 5, 7.
• However, some studies suggest that TXA may reduce all-cause mortality in upper gastrointestinal bleeding 3, 6.
• The safety profile of TXA appears to be acceptable, but caution is needed due to the potential risk of seizures 5.