From the Guidelines
Tranexamic acid (TXA) is not recommended for stopping a lower gastrointestinal (GI) bleed outside of a clinical trial setting. The use of TXA in lower GI bleeding is not well established, and the evidence is limited and inconclusive 1. While TXA has been shown to be effective in reducing bleeding in patients with upper GI bleeding, its effectiveness in lower GI bleeding is uncertain. The British Society of Gastroenterology guidelines suggest that the use of TXA in acute lower GI bleeding be confined to clinical trials, pending the results of the HALT-IT trial 1.
- The HALT-IT trial is a large, randomized controlled trial that aims to determine the effectiveness of TXA in stopping bleeding in patients with acute lower GI bleeding.
- Upper GI bleeding studies have shown that TXA can reduce bleeding, but these results may not be applicable to lower GI bleeding due to differences in the underlying causes of bleeding.
- Trauma patients have been shown to benefit from TXA, with reduced risk of death from bleeding, but this population may not be representative of patients with lower GI bleeding 1.
- Cirrhosis patients with variceal bleeding should not be given TXA, as it may increase the risk of thromboembolic events 1.
- Dosing and administration of TXA in lower GI bleeding are not established, and more research is needed to determine the optimal dose and administration schedule.
From the FDA Drug Label
Tranexamic Acid (TXA) and Lower Gastrointestinal (GI) Bleed
The provided FDA Drug Label for tranexamic acid (TXA) does not directly address its use in stopping a lower gastrointestinal (GI) bleed.
Mechanism of Action
- Tranexamic acid is a synthetic lysine amino acid derivative that diminishes the dissolution of hemostatic fibrin by plasmin 2.
- The antifibrinolytic effects of tranexamic acid are mediated by reversible interactions at multiple binding sites within plasminogen.
Clinical Use
There is no information in the provided Drug Label that suggests tranexamic acid is indicated for the treatment of lower GI bleeds.
Pharmacokinetics and Pharmacodynamics
- Tranexamic acid in concentrations of 1 mg/mL and 10 mg/mL prolongs the thrombin time 2.
- An antifibrinolytic concentration of tranexamic acid remains in different tissues for about 17 hours and in the serum, up to seven or eight hours 2.
Since the provided FDA Drug Label does not contain information relevant to the use of tranexamic acid in stopping a lower GI bleed, it cannot be determined from this source whether TXA is effective for this purpose.
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 and unclear 3, 4.
- Most studies have focused on the use of TXA in upper GI bleeding, with some suggesting that it may reduce rebleeding and mortality in this context 5, 6, 7.
- 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, but the specific results for lower GI bleeding are not yet clear 4.
Available Evidence on Upper GI Bleed
- Several studies have demonstrated that TXA may be effective in reducing bleeding, rebleeding, and mortality in patients with upper GI bleeding 3, 5, 6, 7.
- A systematic review and meta-analysis found that TXA significantly reduced the rates of continued bleeding, urgent endoscopic intervention, and mortality in patients with upper GI bleeding 3.
- Another study found that TXA probably decreases rebleeding and mortality, without increasing thromboembolic adverse effects in patients with upper GI bleeding 5.
Need for Further Clarification
- The effects of TXA on lower GI bleeding warrant further clarification, with more research needed to determine its effectiveness in this context 3, 4.
- The results of the HALT-IT trial may provide more insight into the use of TXA in lower GI bleeding, but until then, the evidence remains limited and unclear 4.