From the Guidelines
Tranexamic Acid (TXA) is not recommended as a standard treatment to stop a gastrointestinal (GI) bleed.
Rationale
- The use of TXA in acute GI bleeding has been studied, but the evidence is not strong enough to support its routine use 1.
- A meta-analysis of trials on TXA in upper GI bleeding showed a reduction in mortality, but this benefit was not apparent when only low-risk bias trials were considered 1.
- The HALT-IT trial, which investigated the use of TXA in acute lower GI bleeding, did not show a clear benefit 1.
- Other studies have raised concerns about the potential harms of TXA, including 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.
- The EASL clinical practice guidelines recommend against the use of tranexamic acid in patients with cirrhosis and active variceal bleeding, citing a lack of benefit and an increased risk of thromboembolic events 1.
- TXA may be considered in specific cases, such as hereditary hemorrhagic telangiectasia (HHT) with mild GI bleeding, but the evidence is limited and the potential for harm must be carefully weighed 1.
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 effectiveness in stopping gastrointestinal (GI) bleeding, with evidence suggesting it may reduce rebleeding and mortality in patients with upper GI bleeding 2, 3, 4.
- A systematic review and meta-analysis of randomized clinical trials found that TXA significantly reduced the rates of continued bleeding, urgent endoscopic intervention, and mortality compared to placebo 3.
- Another study found that TXA was associated with a lower rate of rebleeding and hospitalization time, without significant adverse effects 5.
Mechanism of Action
- TXA works by inhibiting the breakdown of fibrin clots by plasmin, which helps to reduce bleeding 6.
Clinical Trials
- The HALT-IT trial, an international, randomized, double-blind, placebo-controlled trial, aimed to provide reliable evidence about the effects of TXA in acute upper and lower GI bleeding 6.
- The trial found that TXA reduced death due to bleeding within 5 days of randomization, as well as rebleeding and other secondary outcomes 6.