From the Guidelines
TXA (tranexamic acid) is not recommended as a first-line treatment to stop a GI (gastrointestinal) 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 tranexamic acid 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 tranexamic acid on mortality, and an increased risk of venous thromboembolic events 1.
- The EASL clinical practice guidelines recommend against the use of tranexamic acid in patients with cirrhosis and active variceal bleeding, and suggest that its use be confined to clinical trials 1.
- However, tranexamic acid may be considered in patients with persistent bleeding from mucosal oozing or puncture wound bleeding consistent with impaired clot integrity, as it inhibits clot dissolution 1.
- In patients with hereditary hemorrhagic telangiectasia (HHT), tranexamic acid is recommended for patients with mild GI bleeding, but 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 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