From the Guidelines
Tranexamic Acid (TXA) is not recommended as a standard treatment to stop a Gastrointestinal (GI) bleed, as the current evidence does not support its effectiveness in this setting.
- The European Society of Intensive Care Medicine suggests that there is high certainty of harms with use of high-dose IV TXA and no clear benefit with its general use in gastrointestinal hemorrhage 1.
- A large randomized controlled trial found that TXA did not significantly reduce mortality or the need for transfusions in patients with upper GI bleeding, and was associated with an increased risk of venous thromboembolic events 1.
- The British Society of Gastroenterology recommends that the use of TXA in acute LGIB is confined to clinical trials, pending the results of further studies 1.
- The EASL clinical practice guidelines on prevention and management of bleeding and thrombosis in patients with cirrhosis strongly recommend against the use of TXA in patients with cirrhosis and active variceal bleeding 1.
- However, some studies suggest that TXA may be beneficial in specific situations, such as in patients with postpartum hemorrhage or in those with refractory hemorrhage, but more research is needed to confirm these findings 1.
- In general, the management of GI bleeding should be tailored to the individual patient's underlying condition and risk factors, and should involve a multidisciplinary approach that includes endoscopy, pharmacological therapy, and supportive care.
The FDA Drug Labels for tranexamic acid (PO) do not address this question.
From the Research
Efficacy of Tranexamic Acid in GI Bleeding
- Tranexamic acid has been studied for its potential to reduce bleeding in gastrointestinal (GI) bleeding, with some studies suggesting it may be effective in reducing mortality and bleeding rates 2, 3, 4, 5, 6.
- A 2012 study found that tranexamic acid reduced mortality compared to placebo in patients with upper GI bleeding, but the beneficial effect was not confirmed in subgroup analysis or worst-case scenario analyses 2.
- A 2021 systematic review and meta-analysis found that tranexamic acid significantly reduced the rates of continued bleeding, urgent endoscopic intervention, and mortality compared to placebo in patients with upper GI bleeding 3.
- Another study from 2015 found that tranexamic acid probably decreases rebleeding and mortality without increasing thromboembolic adverse effects in patients with upper GI bleeding 4.
- A 2020 systematic review and meta-analysis found that tranexamic acid was superior to placebo for reducing mortality in patients with upper GI bleeding, with moderate-quality evidence supporting its use 5.
- An earlier study from 2008 also suggested that tranexamic acid may reduce all-cause mortality in patients with upper GI bleeding, but noted that additional evidence was needed before treatment recommendations could be made 6.
Mechanism of Action and Safety
- Tranexamic acid works by reducing hemorrhage through its antifibrinolytic effects, which may help to stabilize clots and prevent further bleeding 2, 3.
- The safety of tranexamic acid in patients with GI bleeding has been evaluated, with some studies finding no significant increase in thromboembolic events or adverse effects 2, 4, 5.
- However, the risk of thromboembolic events should be carefully considered when using tranexamic acid, particularly in patients with a history of thromboembolic disease 2.
Clinical Implications
- The use of tranexamic acid in patients with GI bleeding may be considered as part of a comprehensive treatment plan, particularly in cases where bleeding is severe or uncontrolled 3, 5.
- Early administration of tranexamic acid may be beneficial in reducing bleeding rates and mortality, but further studies are needed to confirm this 3.
- The effectiveness of tranexamic acid in lower GI bleeding is less clear and requires further clarification 3.