Can Tranexamic Acid (TXA) stop a Gastrointestinal (GI) bleed?

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 the 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 acute upper gastrointestinal bleeding, and actually increased the risk of venous thromboembolic events 1.
• The British Society of Gastroenterology recommends that the use of TXA in acute lower gastrointestinal bleeding be 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 also recommend against the use of TXA in patients with cirrhosis and active variceal bleeding 1.
• However, some studies suggest that low-dose or enteral TXA may be helpful in certain cases, but the evidence is limited and more research is needed to fully understand its potential benefits and harms 1.
• In general, the management of GI bleeding should be tailored to the individual patient's underlying condition, risk factors, and other treatment options, and TXA should only be considered on a case-by-case basis.

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 (TXA) has been studied for its potential to stop gastrointestinal (GI) bleeding, with evidence suggesting it may be effective in reducing mortality and bleeding rates 2, 3, 4, 5, 6.
• A 2012 study found that TXA reduced mortality compared to placebo in patients with upper GI bleeding, with a relative risk (RR) of 0.61 (95% CI 0.42-0.89) 2.
• 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 GI bleeding (RR = 0.60; 95% CI, 0.43-0.84) 3.
• Another study published in 2015 found that TXA probably decreases rebleeding and mortality without increasing thromboembolic adverse effects in patients with upper GI bleeding 4.
• A 2008 systematic review found that TXA may reduce all-cause mortality in patients with upper GI bleeding, with a RR of 0.61 (95% CI: 0.42-0.89) 5.
• A 2020 systematic review and meta-analysis found that TXA was superior to placebo for reducing mortality in patients with upper GI bleeding, with a RR of 0.59 (95% CI 0.43-0.82) 6.

Safety and Adverse Effects

• The studies found no significant increase in thromboembolic events or adverse effects with the use of TXA in patients with GI bleeding 2, 3, 4, 5, 6.
• However, the quality of evidence for safety and adverse effects was rated as moderate due to risk of bias 6.

Clinical Implications

• The evidence suggests that TXA may be a useful adjunct in the management of upper GI bleeding, particularly in reducing mortality and bleeding rates 2, 3, 4, 5, 6.
• However, additional higher-quality trials are needed to confirm the efficacy and safety of TXA in this setting 3, 6.