From the Guidelines
Tranexamic acid (TXA) is not recommended as a primary treatment to stop a gastrointestinal (GI) bleed, as its effectiveness in this context is uncertain and may vary depending on the severity and cause of the GI bleed.
- The use of TXA in acute GI bleeding has been evaluated in several studies, with mixed results 1.
- A large randomized placebo-controlled trial including 12,009 patients with acute upper gastrointestinal bleeding found no beneficial effect of TXA in reducing mortality due to bleeding, and an increased risk of venous thromboembolic events was observed in the TXA group 1.
- The EASL clinical practice guidelines recommend against the use of TXA in patients with cirrhosis and active variceal bleeding, citing a lack of evidence for its effectiveness and potential risks 1.
- However, TXA may be considered in specific cases, such as in patients with hereditary hemorrhagic telangiectasia (HHT) and mild GI bleeding, although the evidence for its effectiveness in this context is limited 1.
- Overall, the current evidence suggests that TXA should not be used as a primary treatment for GI bleeding, and its use should be considered on a case-by-case basis, taking into account the underlying cause and severity of the bleeding, as well as the potential risks and benefits.
From the FDA Drug Label
Gastrointestinal Bleed 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
The provided FDA Drug Label does not directly discuss the use of tranexamic acid for gastrointestinal bleeding. However, it does mention gastrointestinal symptoms as potential side effects of overdosage, including nausea, vomiting, and diarrhea 2.
- Gastrointestinal symptoms associated with tranexamic acid overdosage:
- Nausea
- Vomiting
- Diarrhea
- There is no direct information in the provided label regarding the use of tranexamic acid to stop a gastrointestinal bleed.
Since the provided FDA Drug Label does not directly address the use of tranexamic acid for gastrointestinal bleeding, it cannot be determined from this information if TXA can stop a gastrointestinal bleed 2.
From the Research
Effectiveness of Tranexamic Acid in Gastrointestinal Bleeding
- Tranexamic acid (TXA) may be effective in reducing rebleeding and mortality in patients with upper gastrointestinal bleeding, without increasing thromboembolic adverse effects 3.
- A systematic review of randomized trials found that TXA may reduce all-cause mortality in upper gastrointestinal bleeding, but additional evidence is needed to confirm this finding 4.
- In patients with lower gastrointestinal bleeding, TXA may not have a significant effect on blood transfusion requirements 5.
- TXA may be beneficial as adjunctive therapy in treating major upper gastrointestinal bleeding in dialysis patients, reducing the rate of early re-bleeding, repeated endoscopic procedures, and blood transfusions needed 6.
Studies on Tranexamic Acid
- The HALT-IT trial, a large international randomized controlled trial, aims to provide reliable evidence on the effects of TXA in acute upper and lower gastrointestinal bleeding 7.
- A meta-analysis of eight randomized trials found that TXA probably decreases rebleeding and mortality in patients with upper gastrointestinal bleeding 3.
- A double-blind prospective randomized controlled trial found no significant difference in blood transfusion requirements between patients with lower gastrointestinal bleeding treated with TXA or placebo 5.
Patient Populations
- TXA may be effective in reducing mortality and rebleeding in patients with upper gastrointestinal bleeding, including those with peptic ulcer/erosive mucosal disease, oesophageal varices, and malignancy 3, 7.
- In dialysis patients, TXA may be beneficial in treating major upper gastrointestinal bleeding, reducing the rate of early re-bleeding and blood transfusions needed 6.
- The effectiveness of TXA in patients with lower gastrointestinal bleeding is uncertain, with one study finding no significant effect on blood transfusion requirements 5.