From the Guidelines
Tranexamic acid (TXA) is not recommended as a first-line treatment to stop gastrointestinal (GI) bleeding, particularly in patients with variceal bleeding or cirrhosis. According to the EASL clinical practice guidelines on prevention and management of bleeding and thrombosis in patients with cirrhosis 1, TXA should not be used in patients with cirrhosis and active variceal bleeding. This recommendation is based on a large randomized placebo-controlled trial that found no beneficial effect of TXA in reducing mortality from GI bleeding in patients with suspected variceal bleeding and liver disease comorbidity 1.
- The use of TXA in GI bleeding is still a topic of debate, with some studies suggesting a potential benefit in reducing mortality 1, while others have raised concerns about its effectiveness and safety 1.
- The HALT-IT trial, a large randomized controlled trial, found that TXA did not reduce mortality or rebleeding in patients with GI bleeding, and actually increased the risk of venous thromboembolic events 1.
- In patients with cirrhosis, the use of TXA is discouraged due to the increased risk of thromboembolic events and the lack of evidence supporting its effectiveness in reducing bleeding or mortality 1.
- The management of GI bleeding should be tailored to the individual patient's underlying condition and risk factors, and should include the use of portal hypertension-lowering measures, endoscopic treatment, and local measures to control bleeding 1.
From the FDA Drug Label
Tranexamic Acid (TXA) and Gastrointestinal (GI) Bleeding
Overview of TXA
Tranexamic acid (TXA) is an antifibrinolytic agent that is used to prevent or treat excessive blood loss from major trauma, postpartum bleeding, and other conditions.
GI Bleeding and TXA
- The provided FDA Drug Label for tranexamic acid (PO) does not directly address the use of TXA for stopping gastrointestinal (GI) bleeding 2.
- The label mentions potential gastrointestinal symptoms of overdosage, such as nausea, vomiting, and diarrhea, but does not discuss the treatment of GI bleeding.
- There is no information in the provided label that suggests TXA is used to stop GI bleeding.
Summary of Findings
| Condition | TXA Use |
|---|---|
| GI Bleeding | Not addressed in the provided label |
| Overdosage symptoms | Gastrointestinal (nausea, vomiting, diarrhea) |
Since the provided FDA Drug Label does not address the use of TXA for GI bleeding, there is not enough information to determine if TXA can stop gastrointestinal bleeding 2.
From the Research
Efficacy of Tranexamic Acid in GI Bleeding
- Tranexamic acid (TXA) has been studied for its effectiveness in stopping gastrointestinal (GI) bleeding, with evidence suggesting it can reduce rebleeding and mortality in patients with upper GI bleeding 3, 4, 5, 6, 7.
- A meta-analysis of randomized controlled trials found that TXA significantly reduced the rates of continued bleeding, urgent endoscopic intervention, and mortality compared to placebo 5.
- Another study found that combining TXA with acid suppression significantly reduced the risk of rebleeding, units of blood transfused, and the need for salvage therapy compared to acid suppression alone 4.
Benefits and Risks
- The use of TXA in upper GI bleeding has been associated with a reduced risk of death, with a relative risk of 0.59 compared to placebo 7.
- There is no significant difference in the risk of thromboembolic events between TXA and placebo 3, 6.
- The quality of evidence for the efficacy of TXA in reducing mortality is rated as moderate due to risk of bias 7.
Clinical Implications
- The available evidence suggests that TXA is an effective medication for patients with upper GI bleeding, and early administration may be recommended for treating upper GI bleeding in the emergency department 5.
- Further trials are needed to determine the optimal dose and route of TXA administration for better care, as well as to clarify the effects of TXA on lower GI bleeding 4, 5.