Can Tranexamic Acid (TXA) stop a gastrointestinal (GI) bleed?

From the Guidelines

Tranexamic acid (TXA) is not recommended as a first-line treatment to stop a gastrointestinal (GI) bleed, particularly in patients with variceal bleeding or those with cirrhosis, due to the lack of clear benefits and potential harms, including an increased risk of thromboembolic events 1.

Key Points

• The use of TXA in GI bleeding is not universally accepted, and its effectiveness is still a topic of debate 1.
• A large randomized controlled trial found no beneficial effect of TXA in patients with acute upper gastrointestinal bleeding, including those with suspected variceal bleeding and liver disease comorbidity 1.
• The European Society of Intensive Care Medicine recommends against the general use of high-dose IV TXA in gastrointestinal hemorrhage due to high certainty of harms and no clear benefit 1.
• In patients with cirrhosis and active variceal bleeding, TXA should not be used, and correction of haemostatic abnormalities is not indicated if haemostasis is achieved with portal hypertension-lowering drugs and endoscopic treatment 1.
• TXA may be considered on a case-by-case basis in patients with cirrhosis who are actively bleeding from a non-portal hypertensive cause, but routine use is discouraged 1.

Clinical Considerations

• The decision to use TXA in GI bleeding should be made on a case-by-case basis, taking into account the individual patient's underlying condition and risk factors.
• Alternative treatments, such as endoscopic therapy, portal hypertension-lowering drugs, and local measures, should be considered first-line options for managing GI bleeding.
• The potential risks and benefits of TXA should be carefully weighed, and its use should be monitored closely for signs of thromboembolic events or other adverse effects.

From the FDA Drug Label

Tranexamic Acid (TXA) and Gastrointestinal (GI) Bleed

There is no information in the provided FDA Drug Label [ 2 ] that suggests Tranexamic Acid (TXA) is used to stop a gastrointestinal (GI) bleed.

Indications for Tranexamic Acid

The label indicates that Tranexamic Acid tablets are a prescription medicine used to treat heavy monthly periods (menstruation) when bleeding gets in the way of social, leisure, and physical activities [ 2 ].

Key Points

• Tranexamic Acid tablets do not contain any hormones.
• On average, Tranexamic Acid tablets have been shown to lower the amount of blood lost during the monthly period by about one-third.
• Tranexamic Acid tablets are taken only during the period and are not meant to treat pre-menstrual symptoms.
• Tranexamic Acid tablets do not affect fertility and cannot be used as birth control.

Dosage and Administration

The recommended dosage is 2 tablets of 650 mg three times per day, for a maximum of 5 days [ 2 ].

Warnings and Precautions

The label warns of the risk of venous and arterial thrombosis or thromboembolism, and advises patients to discontinue use and report any visual and ocular symptoms to their healthcare provider [ 2 ].

There is no information in the provided FDA Drug Label that supports the use of Tranexamic Acid to stop a gastrointestinal (GI) bleed.

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.
• A systematic review and meta-analysis of randomized clinical trials found that TXA significantly reduced the rates of continued bleeding, urgent endoscopic intervention, and mortality compared to placebo 4.
• Another study found that TXA may reduce all-cause mortality in patients with upper GI bleeding, but additional evidence is needed to make treatment recommendations 6.
• A randomized clinical trial found that TXA was associated with a lower rate of rebleeding and hospitalization time, without significant adverse effects, but had no effect on mortality associated with severe upper GI bleeding 7.

Mechanism of Action

• TXA is an antifibrinolytic agent that may help stop bleeding by inhibiting the breakdown of fibrin clots 3, 4.
• The exact mechanism of action of TXA in GI bleeding is not fully understood, but it is thought to involve the inhibition of fibrinolysis and the stabilization of fibrin clots 6.

Clinical Implications

• The use of TXA in patients with upper GI bleeding may be beneficial in reducing rebleeding and mortality, but more research is needed to fully understand its effects 3, 4, 5.
• TXA may be considered as a treatment option for patients with upper GI bleeding, particularly those with severe bleeding or those who are at high risk of rebleeding 4, 7.
• Further studies are needed to determine the optimal dosage and duration of TXA treatment for GI bleeding, as well as its potential benefits and risks in different patient populations 6, 5.