From the Guidelines
TXA (tranexamic acid) is not recommended as a primary treatment to stop a GI (gastrointestinal) bleed, as the current evidence suggests that its benefits in this context are uncertain and may be outweighed by the risks of thromboembolic events.
- The British Society of Gastroenterology guidelines suggest that the use of tranexamic acid in acute lower gastrointestinal bleeding should be confined to clinical trials, pending the results of the HALT-IT trial 1.
- A study published in the Journal of Hepatology found that tranexamic acid did not have a beneficial effect in patients with variceal bleeding and may even increase the risk of venous thromboembolic events 1.
- The AGA clinical practice update on coagulation in cirrhosis suggests that anti-fibrinolytic therapy, including tranexamic acid, may be considered in patients with persistent bleeding from mucosal oozing or puncture wound bleeding, but notes that neither ε-amino caproic acid nor tranexamic acid is believed to generate a hypercoagulable state 1.
- The EASL clinical practice guidelines on prevention and management of bleeding and thrombosis in patients with cirrhosis recommend against the use of tranexamic acid in patients with cirrhosis and active variceal bleeding, and also discourage its routine use in patients with cirrhosis undergoing invasive procedures 1.
- A study on hereditary hemorrhagic telangiectasia recommends tranexamic acid for patients with mild GI bleeding, but notes that there is limited evidence of effectiveness 1.
From the FDA Drug Label
TXA and GI Bleed
The provided FDA Drug Label for tranexamic acid (PO) does not directly address the use of TXA to stop a GI bleed [@@1@@].
Adverse Effects
The label mentions potential gastrointestinal symptoms associated with overdosage, including:
- Nausea
- Vomiting
- Diarrhea
However, this information does not provide evidence for the effectiveness of TXA in stopping a GI bleed [@@1@@].
Relevant Information
There is no relevant information in the provided Drug Label to assist in answering the question of whether TXA can stop a GI bleed [@@1@@].
From the Research
Effectiveness of TXA in GI Bleeding
- TXA may decrease rebleeding and mortality in patients with upper gastrointestinal bleeding, without increasing thromboembolic adverse effects 2
- TXA seems appropriate as adjuvant treatment during upper gastrointestinal bleeding, but thromboembolic risk and dosage should be carefully evaluated 3
- A systematic review suggests that TXA may reduce all-cause mortality in upper gastrointestinal bleeding, but additional evidence is needed due to limitations in the internal and external validity of included trials 4
TXA in Lower GI 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 5
- There was no difference in the consumption of packed red blood cells units among patients in the placebo and TXA groups in the same trial 5
Mechanism of Action
- TXA reduces bleeding by inhibiting the breakdown of fibrin clots by plasmin 6, 5
- TXA has been shown to reduce the need for blood transfusion in trauma, surgical procedures, and upper gastrointestinal bleeding 6, 5
Ongoing Research
- The HALT-IT trial aims to provide reliable evidence about the effects of TXA in acute upper and lower GI bleeding, with a primary outcome of death due to bleeding within 5 days of randomization 6