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 setting.
- 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 including 12,009 patients with acute upper gastrointestinal bleeding found no beneficial effect of TXA on mortality, and an increased risk of venous thromboembolic events 1.
- 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.
- TXA may be considered for patients with hereditary hemorrhagic telangiectasia (HHT) and mild GI bleeding, but the evidence for its effectiveness is limited 1.
- The use of TXA is recommended in trauma patients who are bleeding or at risk of significant hemorrhage, with a loading dose of 1 g infused over 10 minutes, followed by an intravenous infusion of 1 g over 8 h, but this is not directly applicable to GI bleeding 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
- The provided drug labels for tranexamic acid (TXA) do not contain direct information about its use in stopping gastrointestinal (GI) bleeding.
- The labels discuss the use of TXA in patients with hemophilia for short-term use to reduce or prevent hemorrhage and the need for replacement therapy during and following tooth extraction 2.
- They also describe the mechanism of action of TXA as an antifibrinolytic agent that diminishes the dissolution of hemostatic fibrin by plasmin 2.
- Additionally, the labels provide information on overdose symptoms, pharmacokinetics, and pharmacodynamics of TXA, but do not specifically address its effectiveness in stopping GI bleeding 2, 2, 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 evidence suggesting it can reduce rebleeding and mortality in patients with upper GI bleeding 3, 4, 5, 6.
- A systematic review and meta-analysis of randomized trials found that TXA probably decreases rebleeding and mortality, without increasing thromboembolic adverse effects in patients with upper GI bleeding 3.
- Another study found that early TXA administration reduced the risk of mortality in patients with GI bleeding, compared to late treatment, without increasing thromboembolic events 4.
Reduction in Mortality and Rebleeding
- TXA has been shown to reduce all-cause mortality in patients with upper GI bleeding, with a relative risk (RR) of 0.61 (95% CI: 0.42-0.89) 5.
- A meta-analysis of 13 randomized controlled trials found that TXA significantly reduced the rates of continued bleeding (RR = 0.60; 95% CI, 0.43-0.84), urgent endoscopic intervention (RR = 0.35; 95% CI, 0.24-0.50), and mortality (RR = 0.60; 95% CI, 0.45-0.80) compared to placebo 6.
Safety and Adverse Effects
- The evidence suggests that TXA does not significantly increase the risk of thromboembolic disease in patients with GI bleeding 3, 4, 5.
- However, the effects of TXA on lower GI bleeding warrant further clarification, and more research is needed to fully understand its safety and efficacy in this context 6.
Timing of TXA Administration
- Early TXA administration has been associated with a reduced risk of mortality in patients with GI bleeding, compared to late treatment 4.
- The optimal timing of TXA administration is still unclear and requires further study.