From the Guidelines
Tranexamic acid (TXA) is not recommended as a standard treatment to stop gastrointestinal (GI) bleeding, as the current evidence does not support its effectiveness in this context.
- 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.
- A large randomized placebo-controlled trial found no beneficial effect of TXA in patients with acute upper gastrointestinal bleeding, and even reported an increased incidence of venous thromboembolic events in the TXA group 1.
- The European Society of Intensive Care Medicine guidelines state that there is high certainty of harms with the use of high-dose IV TXA and no clear benefit with its general use in gastrointestinal hemorrhage 1.
- However, some studies suggest that low-dose or enteral TXA may be helpful in certain cases, such as in patients with hereditary hemorrhagic telangiectasia (HHT) and mild GI bleeding, although the evidence is limited 1.
- Further research is needed to evaluate the role of TXA in GI bleeding, including its potential use as rescue therapy in refractory hemorrhage 1.
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 with replacement therapy before extraction, and 10 mg/kg 3 to 4 times daily for 2 to 8 days after extraction | [2] |
| Contraindications | Subarachnoid hemorrhage, active intravascular clotting, severe hypersensitivity reactions to tranexamic acid or any of the ingredients | [2] |
| Warnings and Precautions | Risk of thrombosis, medication errors due to incorrect route of administration, 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 (orthostatic symptoms), thromboembolic (arterial, venous, embolic), neurologic (visual impairment, convulsions, headache, mental status changes), myoclonus, rash | [2] |
Key Points
- Tranexamic acid is indicated for short-term use (2 to 8 days) to reduce or prevent hemorrhage and reduce the need for replacement therapy during and following tooth extraction in patients with hemophilia 2, 2.
- The dosage and administration of tranexamic acid vary depending on the patient's condition and weight 2.
- Tranexamic acid has several contraindications, warnings, and precautions, including risk of thrombosis, medication errors, seizures, hypersensitivity reactions, visual disturbances, and dizziness 2.
- Common adverse reactions to tranexamic acid include nausea, vomiting, diarrhea, allergic dermatitis, giddiness, hypotension, and thromboembolic events 2.
- Overdose symptoms of tranexamic acid may include gastrointestinal, hypotensive, thromboembolic, neurologic, and other symptoms 2.
From the Research
Effectiveness of Tranexamic Acid in GI Bleeding
- Tranexamic acid (TXA) has been studied for its effectiveness in stopping gastrointestinal (GI) bleeding, with varying results depending on the specific context and dosage 3, 4, 5, 6, 7.
- In the context of upper GI bleeding, TXA has been shown to probably decrease rebleeding and mortality without increasing thromboembolic adverse effects 3.
- 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 5.
- However, the effectiveness of TXA in lower GI bleeding is less clear, with one study finding no significant effect on blood transfusion requirements 6.
Dosage and Administration
- The dosage and administration of TXA may play a crucial role in its effectiveness, with high-dose IV TXA not reducing mortality or bleeding outcomes and increasing adverse events 7.
- Low-dose IV or enteral TXA may be effective in reducing hemorrhage, but more evidence is required to demonstrate its safety 7.
- Early administration of TXA may be worth recommending for treating upper GI bleeding in the emergency department 5.