From the Guidelines
Tranexamic Acid (TXA) is not recommended as a first-line treatment to stop gastrointestinal bleeding outside of clinical trials. The use of TXA in acute lower gastrointestinal bleeding (LGIB) is still uncertain, as studies have shown mixed results, and its benefit in reducing mortality is not consistently demonstrated, especially when limited to trials with low risk of bias 1. While TXA has been shown to improve mortality in trauma patients with bleeding 1, its application in GI bleeding is less clear. The British Society of Gastroenterology suggests that TXA may be beneficial in acute GI bleeding, with a pooled analysis showing a 40% risk reduction in mortality, but this benefit is not apparent in trials with low risk of bias 1.
- The dosage of TXA typically used in trauma patients is a loading dose of 1 g infused over 10 minutes, followed by an intravenous infusion of 1 g over 8 hours 1.
- Potential risks of TXA include thromboembolic events, although studies have been too small to assess this risk in the context of GI bleeding 1.
- Alternative treatments for GI bleeding, such as vasoactive drugs (e.g., terlipressin, octreotide) and non-selective beta-blockers, may be considered, especially in patients with bleeding anorectal varices 1.
- Anti-fibrinolytic therapy, including TXA and ε-amino caproic acid, may be considered in patients with persistent bleeding from mucosal oozing or puncture wound bleeding consistent with impaired clot integrity 1.
From the FDA Drug Label
Gastrointestinal Bleeding and Tranexamic Acid
Tranexamic acid (TXA) is used for various medical conditions, but its primary use is to prevent or treat excessive blood loss from major trauma, postpartum bleeding, surgery, tooth removal, nosebleeds, and heavy menstruation 2.
Mechanism of Action
TXA works by inhibiting the breakdown of fibrin clots, which are essential for stopping bleeding. However, the provided FDA Drug Label does not directly address the use of TXA for gastrointestinal bleeding.
Side Effects
According to the provided FDA Drug Label 2, gastrointestinal side effects of TXA may include:
- Nausea
- Vomiting
- Diarrhea
These side effects suggest that TXA may not be suitable for stopping gastrointestinal bleeding, as it could potentially worsen the condition. However, there is no direct information in the provided label regarding the use of TXA for this specific purpose.
Relevant Information
There is no information in the provided FDA Drug Label 2 that directly supports the use of TXA to stop gastrointestinal bleeding.
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.