From the Guidelines
Tranexamic Acid (TXA) is not recommended to stop a gastrointestinal (GI) bleed.
Rationale
- The use of TXA in acute GI bleeding has been evaluated in several studies, but the evidence is not strong enough to support its routine use 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 2.
- The European Society of Intensive Care Medicine recommends against the use of high-dose IV TXA in gastrointestinal hemorrhage due to high certainty of harms and no clear benefit 3.
- 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 the HALT-IT trial 1.
Key Points
- TXA may reduce deaths due to hemorrhage in specific situations, such as postpartum hemorrhage, but its use in GI bleeding is not supported by strong evidence 3.
- The risk of venous thromboembolic events associated with TXA use is a concern, particularly in patients with comorbid liver disease or suspected variceal bleeding 2.
- Other treatment options, such as endoscopic therapy and portal hypertension-lowering drugs, are recommended for the management of GI bleeding 2.
The FDA Drug Labels for tranexamic acid (PO) do not address this question.
From the Research
Efficacy of Tranexamic Acid in GI Bleeding
- Tranexamic acid (TXA) has been studied for its potential to stop gastrointestinal (GI) bleeding, with evidence suggesting it may be effective in reducing rebleeding and mortality in patients with upper GI bleeding 4, 5, 6, 7.
- A systematic review and meta-analysis of randomized controlled trials found that TXA significantly reduced the rates of continued bleeding, urgent endoscopic intervention, and mortality compared to placebo in patients with upper GI bleeding 5.
- Another study found that TXA may reduce all-cause mortality in patients with upper GI bleeding, although the evidence was limited by the internal and external validity of the included trials 6.
- The HALT-IT trial, a large international randomized controlled trial, aimed to provide reliable evidence on the effects of TXA in acute upper and lower GI bleeding, with primary outcomes including death due to bleeding within 5 days of randomization and secondary outcomes such as rebleeding and thromboembolic events 8.
Safety and Potential Side Effects
- The evidence suggests that TXA does not increase the risk of thromboembolic adverse effects in patients with upper GI bleeding 4, 6.
- However, the effects of TXA on lower GI bleeding warrant further clarification, and additional higher-quality trials are needed to fully understand its efficacy and safety in this context 5, 7.
Clinical Implications
- Moderate-quality evidence supports the use of TXA for reducing mortality in patients with upper GI bleeding, although additional higher-quality trials are needed to confirm these findings 7.
- Early administration of TXA may be recommended for treating upper GI bleeding in the emergency department, although further research is needed to fully understand its potential benefits and risks 5.