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 with replacement therapy before extraction, and 10 mg/kg 3 to 4 times daily for 2 to 8 days after extraction (2) | (2) |
| Contraindications | Subarachnoid hemorrhage, active intravascular clotting, severe hypersensitivity reactions to tranexamic acid or any of the ingredients (2) | (2) |
| Warnings and Precautions | Risk of thrombosis, medication errors due to incorrect route of administration, seizures, hypersensitivity reactions, visual disturbances, dizziness (2) | (2) |
| Adverse Reactions | Nausea, vomiting, diarrhea, allergic dermatitis, giddiness, hypotension, thromboembolic events (2) | (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) |
Gastrointestinal Bleed Information
- There is no specific information on the use of tranexamic acid to stop a gastrointestinal (GI) bleed 2" class="font-inter font-medium text-primary-blue hover:text-primary-blue/80 transition-colors duration-150">(2), 2" class="font-inter font-medium text-primary-blue hover:text-primary-blue/80 transition-colors duration-150">(2), 2" class="font-inter font-medium text-primary-blue hover:text-primary-blue/80 transition-colors duration-150">(2).
- The indications and usage section only mentions the use of tranexamic acid in patients with hemophilia for short-term use to reduce or prevent hemorrhage and reduce the need for replacement therapy during and following tooth extraction 2" class="font-inter font-medium text-primary-blue hover:text-primary-blue/80 transition-colors duration-150">(2), 2" class="font-inter font-medium text-primary-blue hover:text-primary-blue/80 transition-colors duration-150">(2).
From the Research
Effectiveness of Tranexamic Acid in GI Bleeding
- Tranexamic acid (TXA) 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.
- A systematic review and meta-analysis of randomized controlled trials found that TXA 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 TXA probably decreases rebleeding and mortality, without increasing thromboembolic adverse effects in patients with upper gastrointestinal bleeding 4.
Dosage and Administration
- The effectiveness of TXA in GI bleeding may depend on the dosage and administration route, with high-dose IV TXA not showing a significant reduction in mortality or bleeding outcomes, but increasing adverse events such as deep venous thrombosis, pulmonary embolism, and seizure 6.
- Low-dose IV or enteral TXA may be effective in reducing hemorrhage, but more evidence is required to demonstrate its safety 6.
Limitations and Future Directions
- The current evidence on the use of TXA in GI bleeding is limited by the heterogeneity of the studies and the lack of standardization in the dosage and administration of TXA 3, 6.
- Further studies are needed to clarify the effects of TXA on lower gastrointestinal bleeding and to determine the optimal dosage and administration route for TXA in GI bleeding 3, 6.