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 improve mortality from trauma when given intravenously in the acute setting 1, and several trials have shown a benefit in acute GI bleeding, with 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, and the studies were considered historic and before the routine use of high-dose acid suppression and endoscopic therapy 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.
- TXA should be administered as early as possible to the trauma patient who is bleeding or at risk of significant hemorrhage, and within 3 h after injury 1.
- The use of TXA in acute LGIB is currently suggested to be confined to clinical trials, pending the results of the HALT-IT trial 1.
- Other antifibrinolytic agents, such as ε-aminocaproic acid, may be considered as alternatives to TXA, but their potency is 10-fold weaker and they require continuous infusion to maintain therapeutic drug levels 1.
- The risk of precipitated thrombosis with the use of TXA remains a concern, although the CRASH-2 trial showed that the rate of thrombosis was lower with the use of TXA 1.
- In patients with cirrhosis, anti-fibrinolytic therapy with TXA or ε-amino caproic acid may be considered in patients with persistent bleeding from mucosal oozing or puncture wound bleeding consistent with impaired clot integrity 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