From the Guidelines
Tranexamic Acid (TXA) is not recommended as a first-line treatment to stop a lower GI bleed. The use of TXA in lower GI bleeding is still being studied, and current evidence suggests that its effectiveness is uncertain 1. In the context of upper GI bleeding, TXA has been shown to reduce mortality by 40% in pooled analysis, but this benefit was no longer apparent when the analysis was limited to trials at low risk of bias 1. Furthermore, a large randomized placebo-controlled trial of 12,009 patients with acute upper gastrointestinal bleeding found no beneficial effect of TXA in reducing mortality, and actually observed an increased incidence of venous thromboembolic events in the TXA group 1.
- The British Society of Gastroenterology guidelines suggest that the use of TXA in acute lower GI bleeding should be confined to clinical trials, pending the results of the HALT-IT trial 1.
- The EASL clinical practice guidelines on prevention and management of bleeding and thrombosis in patients with cirrhosis also recommend against the use of TXA in patients with cirrhosis and active variceal bleeding, citing a lack of benefit and potential increased risk of thromboembolic events 1.
- Overall, while TXA may have a role in certain cases of bleeding, the current evidence does not support its routine use in stopping lower GI bleeds.
The FDA Drug Labels for tranexamic acid (PO) do not address this question.
From the Research
Effectiveness of Tranexamic Acid in Lower GI Bleed
- The effectiveness of Tranexamic Acid (TXA) in stopping a Lower Gastrointestinal (GI) Bleed is uncertain, with some studies suggesting it may not be effective in reducing blood transfusion requirements or mortality in patients with lower GI bleeding 2, 3.
- A double-blind prospective randomized controlled trial found that intravenous TXA had no significant effect on blood requirement in patients with lower GI bleeding, with no difference in the consumption of packed red blood cells (PRBC) units among the patients in the placebo and TXA groups 2.
- A systematic review and meta-analysis of RCTs found that TXA did not reduce mortality in patients with acute upper or lower gastrointestinal bleeding and may confer an increased risk of seizures 3.
- Another study found that TXA significantly reduced the rates of continued bleeding, urgent endoscopic intervention, and mortality in patients with upper GI bleeding, but the effects of TXA on lower GI bleeding warrant further clarification 4.
Comparison with Upper GI Bleed
- In contrast, moderate-quality evidence suggests that TXA is superior to placebo for the reduction in mortality in patients with upper GI bleeding 5.
- A systematic review with meta-analysis found that TXA reduced the risk of death in patients with upper GI bleeding, with a risk ratio of 0.59 (95% CI 0.43-0.82, P = 0.001) 5.
- However, the evidence for the effectiveness of TXA in lower GI bleeding is limited and inconclusive, with some studies suggesting it may not be effective in reducing blood transfusion requirements or mortality in patients with lower GI bleeding 2, 3.