From the Guidelines
Tranexamic acid (TXA) is not recommended as a standard treatment to stop gastrointestinal bleeding, as the current evidence does not support its effectiveness in this context.
- The British Society of Gastroenterology guidelines suggest that the use of TXA in acute lower gastrointestinal bleeding should be confined to clinical trials, pending the results of the HALT-IT trial 1.
- A large randomized placebo-controlled trial including 12,009 patients with acute upper gastrointestinal bleeding found no beneficial effect of TXA in reducing death due to bleeding, and an increased risk of venous thromboembolic events was observed in the TXA group 1.
- The European Society of Intensive Care Medicine clinical practice guideline states that there is high certainty of harms with the use of high-dose IV TXA and no clear benefit with its general use in gastrointestinal hemorrhage 1.
- However, TXA has been shown to be effective in reducing mortality in trauma patients with significant bleeding, with a recommended dose of 1g infused over 10 minutes, followed by an intravenous infusion of 1g over 8 hours 1.
- The use of TXA in patients with cirrhosis and active variceal bleeding is not recommended due to the increased risk of thromboembolic events and the limited role of hemostasis in variceal bleeding 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
- The effectiveness of Tranexamic Acid (TXA) in stopping gastrointestinal bleeding is uncertain due to methodological weaknesses and small size of existing trials 3.
- 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 before treatment recommendations can be made 4.
- Another study found that TXA probably decreases rebleeding and mortality, without increasing thromboembolic adverse effects in patients with upper gastrointestinal bleeding 5.
- However, a double-blind prospective randomized controlled trial found that intravenous TXA has no significant effect on blood requirement in patients with lower GI bleeding 6.
Tranexamic Acid in Upper Gastrointestinal Bleeding
- TXA may reduce upper gastrointestinal bleeding and stabilize patients before endoscopic treatments 4.
- A review of the literature suggested that TXA seems appropriate as adjuvant treatment during upper gastrointestinal bleeding, but thromboembolic risk and TXA dosage should be carefully evaluated 7.
- TXA has been shown to reduce clot breakdown by inhibiting the action of plasmin, which may help in reducing bleeding in upper gastrointestinal bleeding 3, 5.
Tranexamic Acid in Lower Gastrointestinal Bleeding
- A double-blind prospective randomized controlled trial found that intravenous TXA has no significant effect on blood requirement in patients with lower GI bleeding 6.
- There is limited evidence on the effectiveness of TXA in lower gastrointestinal bleeding, and more research is needed to determine its efficacy in this setting 3.