From the Guidelines
Tranexamic acid (TXA) can be used to help stop a gastrointestinal (GI) bleed, but its effectiveness is still being studied and it is not currently a standard treatment for this condition. TXA is an antifibrinolytic agent that works by inhibiting the breakdown of fibrin clots, which are essential for stopping bleeding 1. In the context of a GI bleed, TXA can help stabilize the clot that forms over the bleeding site, reducing the risk of further bleeding. Several trials of TXA in upper GI bleeding (UGIB) have been carried out, which on pooled analysis showed a 40% risk reduction in mortality 1. However, this treatment benefit for mortality was no longer apparent when the analysis was limited to trials at low risk of bias. The optimal dosage of TXA for GI bleed is not well established, but a loading dose of 1 g infused over 10 minutes, followed by an intravenous infusion of 1 g over 8 hours, has been recommended for trauma patients 1.
- The use of TXA in GI bleed is still being studied, and more research is needed to determine its effectiveness and optimal dosage.
- TXA may be considered in patients with persistent bleeding from mucosal oozing or puncture wound bleeding consistent with impaired clot integrity 1.
- The risk of precipitated thrombosis with the use of TXA remains a concern, and its use should be carefully considered in patients with a history of thrombotic events 1.
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 such as nausea, vomiting, and diarrhea as potential side effects of overdosage 2.
- Gastrointestinal symptoms associated with tranexamic acid overdosage:
- Nausea
- Vomiting
- Diarrhea
- Other symptoms of overdosage:
- Hypotensive symptoms
- Thromboembolic events
- Neurologic symptoms
- Myoclonus
- Rash
There is no direct information in the provided FDA Drug Label regarding the effectiveness of tranexamic acid in stopping a gastrointestinal bleed 2.
From the Research
Effectiveness of Tranexamic Acid in Gastrointestinal Bleeding
- Tranexamic acid (TXA) has been studied for its potential to reduce bleeding and mortality in patients with gastrointestinal bleeding 3, 4, 5, 6, 7.
- The HALT-IT trial, a large international 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% (OR=0.84,95% CI: 0.78 to 0.91, p<0.0001) 7.
- Another systematic review and meta-analysis of randomized clinical trials found that TXA significantly reduced the rates of continued bleeding, urgent endoscopic intervention, and mortality in patients with upper gastrointestinal bleeding 6.
Mechanism of Action and Safety
- TXA works by inhibiting the breakdown of fibrin clots by plasmin, which helps to reduce bleeding 3.
- The safety of TXA in patients with gastrointestinal bleeding has been evaluated, and most studies found no significant increase in thromboembolic events 4, 5, 6, 7.
Clinical Implications
- The use of TXA in gastrointestinal bleeding may be beneficial in reducing bleeding and mortality, particularly in patients with upper gastrointestinal bleeding 4, 6.
- Early administration of TXA may be worth recommending for treating upper gastrointestinal bleeding in the emergency department 6.
- However, the effects of TXA on lower gastrointestinal bleeding warrant further clarification 6.