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

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 1.

Key Points

• In the context of acute upper gastrointestinal bleeding, a large randomized placebo-controlled trial found no beneficial effect of tranexamic acid in reducing mortality due to bleeding, and instead observed an increased risk of venous thromboembolic events 1.
• The use of tranexamic acid in patients with cirrhosis and active variceal bleeding is not recommended due to the limited role of hemostasis in variceal bleeding and the potential for increased thromboembolic events 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 can inhibit clot dissolution 1.
• In patients with hereditary hemorrhagic telangiectasia (HHT), tranexamic acid is recommended for mild GI bleeding due to its low potential for harm, although evidence of effectiveness is limited 1.

Important Considerations

• The decision to use tranexamic acid in GI bleeding should be made on a case-by-case basis, taking into account the underlying cause and severity of the bleeding, as well as the patient's individual risk factors for thromboembolic events.
• Other treatment options, such as endoscopic therapy, vasoactive drugs, and blood transfusions, should be considered as first-line treatments for GI bleeding, depending on the specific clinical scenario.

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

TXA as Adjuvant Treatment

• TXA seems appropriate as adjuvant treatment during upper gastrointestinal bleeding, but thromboembolic risk and TXA dosage should be carefully evaluated 6
• TXA inhibits the degradation of a newly formed fibrin clot and reduces blood loss and transfusion requirements in various clinical scenarios 6