From the Guidelines
Tranexamic acid (TXA) can be effective in stopping a gastrointestinal (GI) bleed, but its use should be confined to clinical trials or specific situations with impaired clot integrity. The evidence suggests that TXA, an antifibrinolytic agent, can improve mortality in acute GI bleeding, with a 40% risk reduction in mortality observed in pooled analysis of several trials 1. However, this benefit was no longer apparent when the analysis was limited to trials at low risk of bias, and the studies were considered historic.
- The recommended dose of TXA is a loading dose of 1 g infused over 10 minutes, followed by an intravenous infusion of 1 g over 8 hours, as shown in the CRASH-2 trial 1.
- TXA has been shown to be effective in reducing the risk of death due to bleeding in trauma patients, with early treatment (≤1 h from injury) significantly reducing the risk of death due to bleeding 1.
- The use of TXA may be considered in patients with persistent bleeding from mucosal oozing or puncture wound bleeding consistent with impaired clot integrity, as it inhibits clot dissolution without generating a hypercoagulable state 1.
- Additionally, TXA may be used to support hemostasis in non-life-threatening major bleeding, particularly in situations with associated coagulopathy or thrombopathy, with a favorable safety profile 1.
From the FDA Drug Label
Tranexamic Acid (TXA) and Gastrointestinal Bleed
The provided FDA Drug Label for tranexamic acid (PO) does not directly address the use of TXA to stop a gastrointestinal bleed [ 2 ].
Symptoms of Overdosage
According to the label, symptoms of overdosage of tranexamic acid may include gastrointestinal issues, such as:
- Nausea
- Vomiting
- Diarrhea However, this information does not indicate that TXA can stop a gastrointestinal bleed.
Relevant Information
There is no relevant information in the provided FDA Drug Label to suggest that tranexamic acid (TXA) can be used to stop a gastrointestinal bleed [ 2 ].
From the Research
Effectiveness of Tranexamic Acid in Gastrointestinal Bleeding
- Tranexamic acid (TXA) has been studied as a potential treatment for gastrointestinal bleeding, with some evidence suggesting it may reduce bleeding and mortality 3, 4, 5, 6.
- 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 compared to placebo 6.
- Another study found that TXA reduced the odds of death by 16% in patients with gastrointestinal bleeding, with no evidence of heterogeneity between trials 7.
Mechanism of Action
- TXA works by inhibiting the breakdown of fibrin clots by plasmin, which can help reduce bleeding 3, 4.
- This mechanism of action suggests that TXA may be effective in reducing bleeding in patients with gastrointestinal bleeding.
Clinical Evidence
- The HALT-IT trial, a large randomized controlled trial, found no evidence that TXA reduces death in patients with gastrointestinal bleeding 3, 7.
- However, 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% 7.
- The evidence suggests that TXA may be effective in reducing bleeding and mortality in patients with upper gastrointestinal bleeding, but the effects on lower gastrointestinal bleeding are less clear 6.