From the Guidelines
Tranexamic Acid (TXA) is not recommended as a primary treatment to stop gastrointestinal bleeding, as the current evidence does not support its effectiveness in this setting.
- The use of TXA in gastrointestinal bleeding is not supported by high-quality evidence, with some studies suggesting a potential increase in thromboembolic events, particularly in patients with underlying cardiovascular disease 1.
- A large randomized controlled trial found no beneficial effect of TXA in patients with acute upper gastrointestinal bleeding, and an increased risk of venous thromboembolic events was observed in the TXA group 1.
- The European Society of Intensive Care Medicine has identified the use of TXA in gastrointestinal bleeding as a research priority, highlighting the need for further studies to determine its effectiveness and safety in this setting 1.
- In patients with cirrhosis and active variceal bleeding, the use of TXA is not recommended, as it may increase the risk of thromboembolic events and has not been shown to improve outcomes 1.
- However, TXA may be considered in patients with hereditary hemorrhagic telangiectasia (HHT) and mild gastrointestinal bleeding, due to its low potential for harm, although the evidence for its effectiveness is limited 1.
From the FDA Drug Label
Tranexamic Acid (TXA) and Gastrointestinal Bleeding
There is no direct information in the provided FDA Drug Label regarding the use of Tranexamic Acid (TXA) to stop gastrointestinal bleeding.
Reported Symptoms of Overdosage
The label does report symptoms of overdosage, which include gastrointestinal symptoms such as:
- Nausea
- Vomiting
- Diarrhea However, these symptoms do not provide information on the use of TXA to stop gastrointestinal bleeding 2.
Lack of Relevant Information
The provided FDA Drug Label does not contain relevant information to answer whether Tranexamic Acid (TXA) can stop gastrointestinal bleeding. There is no mention of its effectiveness in treating or stopping gastrointestinal bleeding 2.
From the Research
Effectiveness of Tranexamic Acid in Gastrointestinal Bleeding
- Tranexamic acid (TXA) has been studied for its potential to reduce gastrointestinal bleeding, with some studies suggesting it may be effective in reducing hemorrhage and mortality 3, 4, 5, 6, 7.
- A 2012 study found that TXA reduced mortality compared to placebo in patients with upper gastrointestinal bleeding, but the beneficial effect was not confirmed in subgroup analysis or worst-case scenario analyses 3.
- A 2021 systematic review and meta-analysis found that TXA significantly reduced the rates of continued bleeding, urgent endoscopic intervention, and mortality compared to placebo in patients with upper gastrointestinal bleeding 4.
- Another study published in 2015 found that TXA probably decreases rebleeding and mortality without increasing thromboembolic adverse effects in patients with upper gastrointestinal bleeding 5.
- A 2008 systematic review found that TXA may reduce all-cause mortality, but additional evidence was needed before treatment recommendations could be made due to limitations in the internal and external validity of included trials 6.
- A 2024 meta-analysis found that combining TXA with acid suppression significantly reduced the risk of rebleeding, units of blood transfused, and the need for salvage therapy in patients with upper gastrointestinal bleeding 7.
Mechanism of Action and Potential Benefits
- TXA works by reducing hemorrhage through its antifibrinolytic effects, which may help stabilize patients before endoscopic treatments 3, 6.
- The use of TXA in combination with acid suppression, such as proton pump inhibitors, may be a effective first-line therapy for upper gastrointestinal bleeding 7.
- Early administration of TXA may be worth recommending for treating upper gastrointestinal bleeding in the emergency department, but further clarification is needed on its effects on lower gastrointestinal bleeding 4.
Safety and Adverse Effects
- The number of patients with any thrombotic event was not significantly increased in the TXA group in some studies 3, 5.
- Adverse events were unclearly reported in some trials, and further studies are needed to fully assess the safety and potential adverse effects of TXA in patients with gastrointestinal bleeding 3, 6.