From the Guidelines
Tranexamic acid (TXA) should not be used as a first-line treatment to stop a lower gastrointestinal bleed outside of a clinical trial setting. The use of TXA in lower gastrointestinal bleeding is not well-established, and the current evidence is limited and inconclusive 1. While TXA has been shown to be effective in reducing mortality from trauma and upper GI bleeding, its effectiveness in lower GI bleeding is uncertain. The British Society of Gastroenterology suggests that the use of TXA in acute lower GI bleeding should be confined to clinical trials, pending the results of the HALT-IT trial 1.
- The mechanism of action of TXA, as an antifibrinolytic agent, may be beneficial in stabilizing and stopping bleeding, but its effectiveness in lower GI bleeding is not well-established.
- The dose and duration of TXA treatment for lower GI bleeding are not well-established, which could affect its efficacy.
- Other management strategies, such as endoscopic, radiologic, and surgical therapy, may be more effective in stopping lower GI bleeds, and treatment decisions should be based on individual patient needs and local expertise 1.
- The European Society of Intensive Care Medicine and the European Association for the Study of the Liver (EASL) also recommend against the routine use of TXA in patients with cirrhosis undergoing invasive procedures or with active bleeding from a non-portal hypertensive cause 1.
The FDA Drug Labels for tranexamic acid (PO) do not address this question.
From the Research
Effectiveness of Tranexamic Acid in Lower Gastrointestinal Bleeding
- There is limited direct evidence on the effectiveness of tranexamic acid (TXA) in stopping a lower gastrointestinal bleed 2, 3.
- Most studies have focused on upper gastrointestinal bleeding, where TXA has been shown to reduce rebleeding and mortality 4, 2, 5, 6.
- The HALT-IT trial aims to provide reliable evidence on the effects of TXA in acute upper and lower GI bleeding, but the results are not yet available 3.
Current Evidence on Tranexamic Acid
- TXA has been shown to reduce bleeding and mortality in upper gastrointestinal bleeding 4, 2, 5, 6.
- The evidence for lower gastrointestinal bleeding is limited, and further clarification is needed 2.
- TXA works by inhibiting the breakdown of fibrin clots by plasmin, which can help reduce bleeding in various clinical scenarios 3, 6.
Considerations for Tranexamic Acid Use
- The risk of thromboembolic events should be carefully evaluated, especially in patients with co-morbidities 3, 6.
- The dosage of TXA should be carefully considered, especially in patients with renal impairment or other co-morbidities 3, 6.
- Further research is needed to determine the effectiveness and safety of TXA in lower gastrointestinal bleeding 2, 3.