From the Guidelines
Tranexamic acid (TXA) should not be used as a standard treatment to stop GI bleeding outside of clinical trials, due to uncertain benefits and potential risks, as suggested by the British Society of Gastroenterology guidelines 1. When considering the use of TXA in GI bleeding, it's essential to weigh the potential benefits against the risks. The evidence from studies on upper GI bleeding suggests that TXA may reduce mortality by 40% when given intravenously in the acute setting 1. However, this benefit was not apparent in trials with low risk of bias, and the studies were considered historic, making their extrapolation to modern day care uncertain 1. Some key points to consider when evaluating the use of TXA in GI bleeding include:
- The potential benefit of TXA in reducing mortality from GI bleeding is uncertain and may not be applicable in modern clinical practice 1.
- TXA has been shown to improve mortality from trauma when given intravenously in the acute setting, but its use in GI bleeding is still being studied 1.
- The use of TXA in acute lower GI bleeding is currently suggested to be confined to clinical trials, pending the results of the HALT-IT trial 1.
- TXA should be used cautiously in patients with thromboembolic risk factors, severe renal impairment, or history of seizures, due to potential risks. In real-life clinical practice, the decision to use TXA in GI bleeding should be made on a case-by-case basis, taking into account the individual patient's risk factors and the uncertainty surrounding the benefits of TXA in this context. The current evidence does not support the routine use of TXA to stop GI bleeding, and its use should be approached with caution, as recommended by the British Society of Gastroenterology guidelines 1.
From the Research
Effectiveness of TXA in GI Bleeding
- TXA has been shown to reduce the rates of continued bleeding, urgent endoscopic intervention, and mortality in patients with upper gastrointestinal bleeding 2.
- A systematic review and meta-analysis found that tranexamic acid significantly reduced the risk of rebleeding, need for surgical interventions, and mortality in patients with upper gastrointestinal bleeding 3.
- Another study found that low-dose IV/enteral tranexamic acid reduced the risk of rebleeding and need for surgery, but did not reduce mortality 4.
- A meta-analysis of randomized controlled trials found that TXA with acid suppression reduced the risk of rebleeding, units of blood transfused, and the need for salvage therapy in patients with upper gastrointestinal bleeding 5.
Safety and Adverse Events
- High-dose IV tranexamic acid has been associated with an increased risk of deep venous thrombosis, pulmonary embolism, and seizure 4.
- Low-dose IV/enteral tranexamic acid may be effective in reducing hemorrhage, but more evidence is required to demonstrate its safety 4.
- A systematic review and individual patient data meta-analysis found that TXA did not increase the odds of vascular occlusive events (VOEs) 6.
Timing and Dosage
- Early administration of TXA may be beneficial in treating upper gastrointestinal bleeding 2.
- The optimal dose and route of TXA administration for gastrointestinal bleeding are still unclear and require further study 5.
- A study found that TXA reduced the odds of death by 16% when administered to patients with bleeding, and by 20% when administered within 3 hours of bleeding onset 6.