Can Tranexamic Acid (TXA) stop gastrointestinal bleeding?

From the Guidelines

Tranexamic acid (TXA) is not recommended as a standard treatment for gastrointestinal bleeding, particularly in patients with variceal bleeding or cirrhosis, due to lack of evidence for its effectiveness and potential increased risk of thromboembolic events.

• The use of TXA in acute upper gastrointestinal bleeding has been evaluated in several studies, including a large randomized controlled trial of 12,009 patients, which found no beneficial effect of TXA on mortality or re-bleeding rates, and an increased risk of venous thromboembolic events 1.
• A guideline from the British Society of Gastroenterology suggests that the use of TXA in acute lower gastrointestinal bleeding should be confined to clinical trials, pending the results of further studies 1.
• In patients with cirrhosis and active variceal bleeding, the use of TXA is not recommended due to the limited role of haemostasis in variceal bleeding and the frequent occurrence of a hypofibrinolytic state in critically ill patients with cirrhosis 1.
• However, some older studies suggest that TXA may have a beneficial effect in reducing the need for surgical intervention and mortality in patients with non-variceal upper gastrointestinal bleeding, particularly those with ulcer bleeding 1.
• Overall, the evidence for the use of TXA in gastrointestinal bleeding is not conclusive, and its use should be carefully considered on a case-by-case basis, taking into account the individual patient's underlying condition, risk factors, and other treatment options.

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

Efficacy of Tranexamic Acid in Gastrointestinal Bleeding

• Tranexamic acid (TXA) has been studied for its potential to stop gastrointestinal bleeding, with evidence suggesting it may be effective in reducing mortality and bleeding rates 3, 4, 5, 6, 7.
• A 2012 systematic review found that TXA reduced mortality compared to placebo in patients with upper gastrointestinal bleeding, although the beneficial effect was not confirmed in subgroup 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 2020 systematic review and meta-analysis found that TXA was superior to placebo in reducing mortality in patients with upper gastrointestinal bleeding, with moderate-quality evidence supporting its use 6.
• An earlier systematic review published in 2008 also suggested that TXA may reduce all-cause mortality in patients with upper gastrointestinal bleeding, although additional evidence was needed to confirm this finding 7.

Mechanism of Action and Safety

• TXA works by reducing haemorrhage through its antifibrinolytic effects, which may help to stabilize patients before endoscopic treatments 3, 4.
• The safety of TXA in patients with gastrointestinal bleeding has been evaluated, with some studies finding no significant increase in thromboembolic events 3, 5, 6.
• However, the risk of adverse events, including thromboembolic disease, should be carefully considered when using TXA in patients with gastrointestinal bleeding 3, 7.

Clinical Implications

• The available evidence suggests that TXA may be a useful adjunctive treatment for patients with upper gastrointestinal bleeding, particularly in reducing mortality and bleeding rates 4, 6.
• However, the quality of the evidence varies, and additional higher-quality trials are needed to confirm the efficacy and safety of TXA in this setting 3, 6, 7.
• Clinicians should carefully consider the potential benefits and risks of TXA when deciding whether to use it in patients with gastrointestinal bleeding, and should be aware of the latest evidence and guidelines on its use 4, 6.