From the Guidelines
TXA (tranexamic acid) is not recommended as a primary treatment to stop a GI (gastrointestinal) bleed, except in specific cases where bleeding is due to mucosal oozing or impaired clot integrity. In the context of GI bleeding, TXA, an antifibrinolytic agent, works by inhibiting the breakdown of fibrin clots, which are essential for stopping bleeding 1. However, its effectiveness in stopping GI bleeds is uncertain and may vary depending on the severity and cause of the bleed.
- The British Society of Gastroenterology suggests 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 found no beneficial effect of TXA in patients with acute upper gastrointestinal bleeding, including those with suspected variceal bleeding and liver disease comorbidity 1.
- The EASL clinical practice guidelines recommend against the use of TXA in patients with cirrhosis and active variceal bleeding, citing a lack of benefit and a potential increase in venous thromboembolic events 1.
- However, TXA may be considered in patients with persistent bleeding from mucosal oozing or puncture wound bleeding consistent with impaired clot integrity, as it can inhibit clot dissolution without generating a hypercoagulable state 1.
- In patients with hereditary hemorrhagic telangiectasia, TXA is recommended for those with mild GI bleeding due to its low potential for harm, although evidence of effectiveness is limited 1.
The FDA Drug Labels for tranexamic acid (PO) do not address this question.
From the Research
Effectiveness of TXA in GI Bleeding
- TXA probably decreases rebleeding and mortality in patients with upper gastrointestinal bleeding, without increasing thromboembolic adverse effects 2
- The HALT-IT trial aims to provide reliable evidence about the effects of TXA in acute upper and lower GI bleeding, with primary outcome being death due to bleeding within 5 days of randomisation 3
- A systematic review suggests that TXA may reduce all-cause mortality in upper gastrointestinal bleeding, but additional evidence is needed before treatment recommendations can be made 4
TXA in Lower GI Bleeding
- A double-blind prospective randomised controlled trial found that intravenous TXA has no significant effect on blood requirement in patients with lower GI bleeding 5
- There was no difference in the consumption of packed red blood cells units among the patients in the placebo and TXA groups in the same trial 5