Can tranexamic acid (TXA) stop a gastrointestinal bleed?

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 pooled analysis showing a 40% risk reduction in mortality 1. However, this benefit was not 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 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.
• In patients with cirrhosis, anti-fibrinolytic therapy, including TXA, may be considered in patients with persistent bleeding from mucosal oozing or puncture wound bleeding consistent with impaired clot integrity 1.
• The use of TXA may also be considered in patients with non-life-threatening major bleeding under non-vitamin K antagonist oral anticoagulants (NOACs), especially in situations of severe bleeding where many factors of the coagulation cascade are deficient 1.

From the FDA Drug Label

Tranexamic Acid (TXA) and Gastrointestinal Bleed

Efficacy of TXA in Stopping Gastrointestinal Bleed

There is no information in the provided FDA Drug Label [ 2 ] that suggests tranexamic acid (TXA) can stop a gastrointestinal bleed. The label only discusses symptoms of overdosage, which may include gastrointestinal issues such as nausea, vomiting, and diarrhea, but does not provide information on the use of TXA for treating gastrointestinal bleeding.

• Symptoms of overdosage:
  • Gastrointestinal: nausea, vomiting, diarrhea
  • Hypotensive: orthostatic symptoms
  • Thromboembolic: arterial, venous, embolic
  • Neurologic: visual impairment, convulsions, headache, mental status changes
  • Myoclonus
  • Rash

Relevant Information

The provided FDA Drug Label [ 2 ] does not contain relevant information to answer the question of whether tranexamic acid (TXA) can stop a gastrointestinal bleed.

From the Research

Efficacy of Tranexamic Acid in Gastrointestinal Bleeding

• Tranexamic acid (TXA) has been studied for its potential to stop gastrointestinal bleeding, with evidence suggesting it may be effective in reducing bleeding and mortality in patients with upper gastrointestinal bleeding 3, 4, 5, 6.
• The HALT-IT trial, a large international randomized controlled trial, aimed to provide reliable evidence on the effects of TXA in acute upper and lower GI bleeding, with primary outcomes including death due to bleeding within 5 days of randomization and secondary outcomes such as rebleeding and all-cause mortality 3.
• 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 in patients with upper gastrointestinal bleeding 6.
• Another study found that TXA probably decreases rebleeding and mortality without increasing thromboembolic adverse effects in patients with upper gastrointestinal bleeding 4.

Safety and Considerations

• The use of TXA in patients with gastrointestinal bleeding should be carefully evaluated, particularly in older patients with co-morbidities, due to the potential risk of thromboembolic events 7.
• The optimal dosage and timing of TXA administration in gastrointestinal bleeding require further clarification, with some studies suggesting early administration may be beneficial in treating upper gastrointestinal bleeding 6.
• The effects of TXA on lower gastrointestinal bleeding are less clear and warrant further study 6.

Clinical Implications

• The available evidence suggests that TXA may be a useful adjunctive treatment in the management of upper gastrointestinal bleeding, potentially reducing bleeding and mortality 4, 5, 6.
• However, the decision to use TXA in clinical practice should be based on individual patient assessment and consideration of the potential benefits and risks, as well as the availability of other treatment options 7.