From the Guidelines
Tranexamic Acid (TXA) is not recommended to stop a gastrointestinal (GI) bleed, as the current evidence suggests it has no clear benefit in this context and may even increase the risk of thromboembolic events 1.
Mechanism and Rationale
TXA works by inhibiting the breakdown of fibrin clots, which could potentially help in stabilizing clots formed at the site of a GI bleed. However, the evidence from studies, including a large randomized placebo-controlled trial, indicates that TXA does not reduce mortality or re-bleeding rates in patients with acute upper gastrointestinal bleeding, including those with suspected variceal bleeding and liver disease comorbidity 1.
Evidence Summary
- A study published in the Journal of Hepatology in 2022 found that TXA should not be used in patients with cirrhosis and active variceal bleeding, due to the lack of benefit and potential for increased thromboembolic events 1.
- Guidelines from the British Society of Gastroenterology suggest that the use of TXA in acute lower gastrointestinal bleeding should be confined to clinical trials, pending further evidence 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, although low-dose or enteral TXA may be considered in specific cases 1.
- In the context of hereditary hemorrhagic telangiectasia, TXA is recommended for patients with mild GI bleeding due to its low potential for harm, but evidence of its effectiveness is limited 1.
Clinical Considerations
The decision to use TXA in a GI bleed should be made on a case-by-case basis, considering the potential risks and benefits. In general, TXA is not recommended for routine use in GI bleeding due to the lack of clear evidence supporting its effectiveness and the potential for adverse effects. Other treatment strategies, such as endoscopic therapy, acid suppression, and supportive care, should be prioritized.
From the FDA Drug Label
Tranexamic Acid (TXA) Information
| Category | Information | Reference |
|---|---|---|
| Indications and Usage | Reduce or prevent hemorrhage and reduce the need for replacement therapy during and following tooth extraction in patients with hemophilia | [2], [2] |
| Dosage and Administration | 10 mg/kg actual body weight intravenously before extraction, 10 mg/kg 3-4 times daily for 2-8 days after extraction | [2] |
| Contraindications | Subarachnoid hemorrhage, active intravascular clotting, severe hypersensitivity reactions | [2] |
| Warnings and Precautions | Risk of thrombosis, medication errors, seizures, hypersensitivity reactions, visual disturbances, dizziness | [2] |
| Adverse Reactions | Nausea, vomiting, diarrhea, allergic dermatitis, giddiness, hypotension, thromboembolic events | [2] |
| Overdose Symptoms | Gastrointestinal (nausea, vomiting, diarrhea), hypotensive, thromboembolic, neurologic | [2] |
Additional Information
- Tranexamic acid is an antifibrinolytic indicated for short-term use (2 to 8 days) in patients with hemophilia [ 2, 2 ]
- The drug is administered intravenously, with a recommended dosage of 10 mg/kg actual body weight [ 2 ]
- Concomitant use of prothrombotic medical products should be avoided due to increased risk of thromboembolic adverse reactions [ 2 ]
From the Research
Efficacy of Tranexamic Acid in GI Bleeding
- Tranexamic acid has been shown to be effective in reducing the rates of continued bleeding, urgent endoscopic intervention, and mortality in patients with upper gastrointestinal bleeding 3, 4, 5, 6.
- A systematic review and meta-analysis of randomized controlled trials found that tranexamic acid significantly reduced the rates of continued bleeding (RR = 0.60; 95%CI, 0.43-0.84) and mortality (RR = 0.60; 95%CI, 0.45-0.80) compared with the placebo 3.
- Another study found that tranexamic acid probably decreases rebleeding and mortality, without increasing thromboembolic adverse effects in patients with upper gastrointestinal bleeding 4.
- However, the effects of tranexamic acid on lower gastrointestinal bleeding warrant further clarification 3.
Dosage and Administration
- The optimal dosage and administration of tranexamic acid for GI bleeding is still unclear, with some studies suggesting that low-dose IV or enteral tranexamic acid may be effective in reducing hemorrhage, while others found that extended-use high-dose IV tranexamic acid did not improve mortality or bleeding outcomes and increased adverse events 7.
- Thromboembolic risk and tranexamic acid dosage should be carefully evaluated, especially in older patients with co-morbidities 5.
Safety and Adverse Events
- The safety profile of tranexamic acid in GI bleeding is still being evaluated, with some studies suggesting that it may increase the risk of deep venous thrombosis, pulmonary embolism, and seizure 7.
- However, other studies found that tranexamic acid did not significantly increase the risk of thromboembolic disease 6.