From the Guidelines
Tranexamic Acid (TXA) is not recommended as a primary treatment to stop gastrointestinal bleeding, as the evidence for its effectiveness in this setting is limited and inconclusive 1.
Mechanism of Action and Potential Benefits
TXA works by inhibiting the breakdown of fibrin clots, which could potentially be beneficial in stopping a gastrointestinal (GI) bleed. However, the use of TXA in GI bleeding may be limited by its potential to increase the risk of thromboembolic events, particularly in patients with underlying cardiovascular disease.
Evidence from Clinical Guidelines
The European Association for the Study of the Liver (EASL) clinical practice guidelines on prevention and management of bleeding and thrombosis in patients with cirrhosis recommend against the use of TXA in patients with cirrhosis and active variceal bleeding 1. Additionally, the guidelines suggest that TXA should not be used in patients with cirrhosis undergoing invasive procedures to decrease the rate of procedure-related clinically relevant bleeding 1.
Specific Patient Populations
In patients with hereditary hemorrhagic telangiectasia (HHT), TXA may be recommended for mild GI bleeding due to its low potential for harm, but there is limited evidence of effectiveness 1. In critically ill adults, further research is required to evaluate the role of TXA in gastrointestinal bleeding 1.
Key Points
- TXA is not recommended as a primary treatment to stop gastrointestinal bleeding
- The evidence for TXA's effectiveness in GI bleeding is limited and inconclusive
- TXA may increase the risk of thromboembolic events, particularly in patients with underlying cardiovascular disease
- Clinical guidelines recommend against the use of TXA in patients with cirrhosis and active variceal bleeding, as well as in patients with cirrhosis undergoing invasive procedures.
From the FDA Drug Label
Gastrointestinal Bleeding and Tranexamic Acid
Tranexamic acid (TXA) is used for various medical conditions, but its primary use is to prevent or treat excessive blood loss from major trauma, postpartum bleeding, surgery, tooth removal, nosebleeds, and heavy menstruation 2.
Mechanism of Action
TXA works by inhibiting the breakdown of fibrin clots, which are essential for stopping bleeding. However, the provided FDA Drug Label does not directly address the use of TXA for gastrointestinal bleeding.
Side Effects
According to the provided FDA Drug Label 2, gastrointestinal side effects of TXA may include:
- Nausea
- Vomiting
- Diarrhea
These side effects suggest that TXA may not be suitable for stopping gastrointestinal bleeding, as it could potentially worsen the condition. However, there is no direct information in the provided label regarding the use of TXA for this specific purpose.
Relevant Information
There is no information in the provided FDA Drug Label 2 that directly supports the use of TXA to stop gastrointestinal bleeding.
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 reduce mortality and bleeding rates 3, 4, 5, 6, 7.
- A 2012 study found that TXA reduced mortality compared to placebo in patients with upper gastrointestinal bleeding, with a relative risk (RR) of 0.61 (95% CI 0.42-0.89) 3.
- A 2021 systematic review and meta-analysis found that TXA significantly reduced continued bleeding, urgent endoscopic intervention, and mortality in patients with upper gastrointestinal bleeding, with RRs of 0.60 (95% CI 0.43-0.84), 0.35 (95% CI 0.24-0.50), and 0.60 (95% CI 0.45-0.80), respectively 4.
- Another study published in 2015 found that TXA probably decreases rebleeding and mortality in patients with upper gastrointestinal bleeding, without increasing thromboembolic adverse effects 5.
- A 2008 systematic review found that TXA may reduce all-cause mortality in patients with upper gastrointestinal bleeding, with an RR of 0.61 (95% CI 0.42-0.89) 6.
- A 2020 systematic review and meta-analysis found that TXA reduced mortality in patients with upper gastrointestinal bleeding, with an RR of 0.59 (95% CI 0.43-0.82) 7.
Safety and Adverse Effects
- The studies found no significant increase in thromboembolic events with TXA use 3, 4, 5, 6, 7.
- Adverse events were unclearly reported in some studies, but available data suggest that TXA is generally well-tolerated 3, 6.
Clinical Implications
- The evidence suggests that TXA may be an effective medication for patients with upper gastrointestinal bleeding, particularly in reducing mortality and bleeding rates 3, 4, 5, 6, 7.
- Early administration of TXA may be recommended for treating upper gastrointestinal bleeding in the emergency department 4.
- However, additional higher-quality trials are needed to confirm the efficacy and safety of TXA in this setting 7.