Can TXA (tranexamic acid) stop a GI (gastrointestinal) bleed?

From the Guidelines

TXA can help stop a GI bleed, but its use is generally recommended in the context of clinical trials or specific high-risk situations. The evidence suggests that tranexamic acid (TXA) can be beneficial in reducing mortality from bleeding, particularly in trauma patients 1. In the context of GI bleeding, TXA has been shown to reduce mortality by 40% in some studies, although this benefit was not apparent in trials with low risk of bias 1. 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.

• Key benefits of TXA:
  • Reduces mortality from bleeding in trauma patients 1
  • May reduce mortality from GI bleeding, although evidence is limited 1
  • Can be administered early, even en route to the hospital, to maximize benefits 1
• Important considerations:
  • TXA should be used with caution, as it may increase the risk of thromboembolic events, although this risk was not apparent in the CRASH-2 trial 1
  • The use of TXA in GI bleeding is generally recommended in the context of clinical trials or specific high-risk situations, such as persistent bleeding from mucosal oozing or puncture wound bleeding 1
  • Other antifibrinolytic agents, such as ε-aminocaproic acid, may be considered as alternatives to TXA, although their efficacy and safety profiles may differ 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
• 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 randomisation 3
• TXA seems appropriate as adjuvant treatment during upper gastrointestinal bleeding, but thromboembolic risk and dosage should be carefully evaluated 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 patients in the placebo and TXA groups in this trial 5

Previous Studies on TXA in GI Bleeding

• A systematic review of seven double-blind randomized trials found that TXA may reduce all-cause mortality in upper gastrointestinal bleeding, but additional evidence is needed before treatment recommendations can be made 6
• Another systematic review found that TXA probably decreases rebleeding and mortality in patients with upper gastrointestinal bleeding, without increasing thromboembolic adverse effects 2