From the Guidelines
Tranexamic Acid (TXA) is not recommended to stop a gastrointestinal (GI) bleed, especially in cases of variceal bleeding, as it has been shown to have no beneficial effect and may even increase the risk of venous thromboembolic events 1.
GI Bleed Context
In the context of GI bleeding, the use of TXA has been evaluated in several studies. 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 even reported an increased incidence of venous thromboembolic events in the TXA group 1.
Non-Variceal Bleeding
For non-variceal bleeding, some studies suggest that TXA may reduce the need for surgical intervention and tend to reduce mortality in ulcer bleeding patients, but further studies are necessary to confirm its effectiveness 1.
Specific Conditions
In patients with hereditary hemorrhagic telangiectasia (HHT), TXA is recommended for mild GI bleeding due to its low potential for harm, but its effectiveness is limited, and systemic antiangiogenic therapy is recommended for moderate to severe GI bleeding 1.
Clinical Considerations
The decision to use TXA in GI bleeding should be made on a case-by-case basis, considering the underlying cause of the bleed, the severity of the bleeding, and the patient's individual risk factors for thromboembolic events. In general, TXA should not be used as a first-line treatment for GI bleeding, and other therapies such as endoscopic treatment, acid suppression, and blood transfusions should be prioritized.
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 can reduce mortality and rebleeding rates 2, 3, 4.
- 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 3.
- Another study found that TXA reduced the risk of death due to bleeding within 5 days of randomization, with a relative risk of 0.59 (95% CI 0.43-0.82) 4.
Mechanism of Action
- TXA works by inhibiting the breakdown of fibrin clots by plasmin, which helps to reduce bleeding 5.
- The Haemorrhage ALleviation with Tranexamic acid - Intestinal system (HALT-IT) trial aimed to provide reliable evidence about the effects of TXA in acute upper and lower GI bleeding 5.
Safety and Adverse Effects
- The available evidence suggests that TXA does not increase the risk of thromboembolic adverse effects in patients with upper GI bleeding 2, 4.
- However, the quality of evidence for mortality and other outcomes was rated as moderate due to risk of bias, and additional higher-quality trials are needed to confirm the findings 4.
Clinical Implications
- The use of TXA in GI bleeding management may be recommended, particularly in the emergency department, due to its potential to reduce mortality and rebleeding rates 3.
- However, further clarification is needed on the effects of TXA on lower GI bleeding, and additional research is required to fully understand its role in GI bleeding management 3, 5.