From the Guidelines
Tranexamic acid (TXA) is not recommended as a primary treatment to stop gastrointestinal bleeding, particularly in cases of variceal bleeding, due to its potential to increase the risk of thromboembolic events without providing a clear benefit in reducing bleeding or mortality 1.
Mechanism of Action and Clinical Use
TXA is an antifibrinolytic agent that works by inhibiting the breakdown of fibrin clots, which are essential for stopping bleeding. However, its effectiveness in gastrointestinal bleeding is limited, and it may even be harmful in certain cases, such as variceal bleeding, where it has been shown to increase the risk of venous thromboembolic events 1.
Evidence from Clinical Trials
A large randomized placebo-controlled trial including 12,009 patients with acute upper gastrointestinal bleeding found no beneficial effect of TXA in reducing mortality due to bleeding, and it actually increased the incidence of venous thromboembolic events, particularly in patients with comorbid liver disease or suspected variceal bleeding 1.
Guidelines and Recommendations
The European Society of Intensive Care Medicine recommends against the use of high-dose IV TXA in gastrointestinal hemorrhage due to the high certainty of harms and no clear benefit 1. The British Society of Gastroenterology suggests that the use of TXA in acute lower gastrointestinal bleeding should be confined to clinical trials, pending the results of further studies 1.
Specific Considerations
In patients with hereditary hemorrhagic telangiectasia (HHT), TXA may be considered for mild gastrointestinal bleeding due to its low potential for harm, but there is limited evidence of its effectiveness 1. In cases of bleeding anorectal varices, TXA is not recommended as a primary treatment, but it may be considered as a rescue therapy in patients with persistent bleeding consistent with impaired clot integrity 1.
Conclusion is not allowed, so the response ends here.
From the FDA Drug Label
Tranexamic Acid Information
| Category | Information | Reference |
|---|---|---|
| Indications and Usage | 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] |
| Dosage and Administration | 10 mg/kg actual body weight intravenously with replacement therapy before extraction, and 10 mg/kg actual body weight 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 with concomitant use of factor IX, risk of 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], [2] |
| Mechanism of Action | Diminishes the dissolution of hemostatic fibrin by plasmin, occupies lysine receptor binding sites of plasmin for fibrin | [2] |
| Pharmacokinetics | Initial volume of distribution: 9-12 liters, plasma protein binding: 3%, elimination half-life: 2 hours | [2] |
Gastrointestinal Bleeding Information
- There is no direct information in the provided drug labels that suggests tranexamic acid is used to stop gastrointestinal bleeding.
- The primary use of tranexamic acid is for short-term use to reduce or prevent hemorrhage and reduce the need for replacement therapy during and following tooth extraction in patients with hemophilia.
- Overdose symptoms of tranexamic acid may include gastrointestinal symptoms such as nausea, vomiting, and diarrhea, but this does not indicate its use for stopping gastrointestinal bleeding. | 2, 2, 2 |
From the Research
Effectiveness of Tranexamic Acid in Gastrointestinal Bleeding
- Tranexamic acid (TXA) has been studied for its effectiveness in stopping gastrointestinal bleeding, with evidence suggesting it may reduce rebleeding and mortality in patients with upper gastrointestinal bleeding 3, 4.
- A systematic review and meta-analysis found that TXA significantly reduced the rates of continued bleeding, urgent endoscopic intervention, and mortality compared to placebo in patients with upper gastrointestinal bleeding 4.
- Another study found that low-dose IV/enteral TXA may be effective in reducing hemorrhage, but more evidence is required to demonstrate its safety 5.
Safety and Adverse Effects
- The use of extended-use high-dose IV TXA has been associated with an increased risk of deep venous thrombosis, pulmonary embolism, and seizure 5.
- However, low-dose IV/enteral TXA did not increase the risk of adverse events, and may be a safer alternative 5.
- A review of randomized trials found that TXA did not significantly increase the risk of thromboembolic disease, but adverse events were unclearly reported 6.
Clinical Applications
- TXA may be useful as an adjuvant treatment for upper gastrointestinal bleeding, but its use should be carefully evaluated in patients with co-morbidities and thromboembolic risk 7.
- Early administration of TXA may be recommended for treating upper gastrointestinal bleeding in the emergency department, but further clarification is needed on its effects in lower gastrointestinal bleeding 4.