From the Guidelines
Tranexamic acid (TXA) is not recommended for stopping a lower gastrointestinal (GI) bleed outside of a clinical trial setting. The British Society of Gastroenterology guidelines suggest 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. While TXA has been shown to be effective in reducing bleeding in patients with upper GI bleeding and trauma, its effectiveness in lower GI bleeding is uncertain. The CRASH-2 trial demonstrated that TXA reduced the risk of death from bleeding in trauma patients, but this study did not specifically address lower GI bleeding 1.
Key Points
- The optimal dose of TXA for lower GI bleeding is not established, but a loading dose of 1 g infused over 10 minutes, followed by an intravenous infusion of 1 g over 8 hours, has been recommended for trauma patients 1.
- The use of TXA in lower GI bleeding may be associated with an increased risk of thromboembolic events, such as deep vein thrombosis and pulmonary embolism.
- Other guidelines, such as those from the European Association for the Study of the Liver, recommend against the use of TXA in patients with cirrhosis and active variceal bleeding, due to the lack of evidence and potential increased risk of thromboembolic events 1.
- Viscoelastic tests may be useful in guiding transfusion and reducing blood product use in patients with cirrhosis and active upper gastrointestinal bleeds, but their role in lower GI bleeding is not established 1.
The FDA Drug Labels for tranexamic acid (PO) do not address this question.
From the Research
Effectiveness of Tranexamic Acid in Lower GI Bleed
- The current evidence on the effectiveness of tranexamic acid (TXA) in lower gastrointestinal (GI) bleeding is limited 2, 3.
- Most studies have focused on upper GI bleeding, and the results may not be directly applicable to lower GI bleeding 4, 5, 6.
- The HALT-IT trial, a large international randomized controlled trial, aimed to provide reliable evidence on the effects of TXA in acute upper and lower GI bleeding 3.
- However, the trial's results on lower GI bleeding specifically are not explicitly stated in the provided evidence.
Upper GI Bleed Studies
- Studies on upper GI bleeding have shown that TXA may reduce mortality, rebleeding, and the need for urgent endoscopic intervention 2, 4, 5, 6.
- The evidence suggests that TXA is effective in reducing bleeding and mortality in upper GI bleeding, but the quality of the evidence is limited by heterogeneity and methodological weaknesses 2, 5, 6.
Lower GI Bleed Evidence
- There is a lack of direct evidence on the effectiveness of TXA in lower GI bleeding, and further studies are needed to clarify its effects in this setting 2, 3.
- The HALT-IT trial's statistical analysis plan includes subgroup analyses for the primary outcome, considering the location of bleeding, which may provide some insight into the effectiveness of TXA in lower GI bleeding 3.