From the Guidelines

Tranexamic Acid (TXA) is not recommended to stop a gastrointestinal (GI) bleed.

The use of TXA in acute GI bleeding has been studied, but the evidence is not strong enough to support its use as a standard treatment 1.
A recent international multicenter, randomized, double-blind, placebo-controlled trial of high-dose TXA as an adjunctive therapy in patients presenting with acute gastrointestinal bleeding showed no reduction in death or bleeding in the TXA arm 1.
The European Association for the Study of the Liver (EASL) clinical practice guidelines on prevention and management of bleeding and thrombosis in patients with cirrhosis recommend against the use of TXA in patients with cirrhosis and active variceal bleeding, citing a lack of benefit and a potential increased risk of venous thromboembolic events 1.

TXA has antifibrinolytic activity, but its use in GI bleeding is not supported by strong evidence.
The HALT-IT trial, a large randomized controlled trial, found no benefit of TXA in reducing death or bleeding in patients with acute upper gastrointestinal bleeding, including those with suspected variceal bleeding and liver disease comorbidity 1.
The use of TXA may be associated with an increased risk of venous thromboembolic events, particularly in patients with comorbid liver disease or suspected variceal bleeding 1.

TXA should not be used as a standard treatment for GI bleeding, including variceal bleeding in patients with cirrhosis.
The management of GI bleeding should focus on prompt initiation of vasoactive therapy, antibiotics, and endoscopic treatment, as well as correction of underlying hemostatic abnormalities on a case-by-case basis 1.

From the Research

Tranexamic acid (TXA) has been shown to be effective in reducing the need for urgent endoscopy in patients with acute gastrointestinal bleeding 2.
A study found that TXA decreased the rate of early re-bleeding, repeated endoscopic procedures, and blood transfusions in dialysis patients with major upper gastrointestinal bleeding 3.
A systematic review with meta-analysis of randomized clinical trials found that TXA significantly reduced the rates of continued bleeding, urgent endoscopic intervention, and mortality in patients with gastrointestinal bleeding 4.
Another overview of systematic reviews found that TXA improved 24-h mortality for gastrointestinal bleeds and decreased long-term gastrointestinal bleed mortality, but also identified an increased risk of thromboembolic events in gastrointestinal bleeding scenarios 5.

The studies used different dosages and administration routes of TXA, including intravenous and topical administration 2, 3.
Early administration of TXA is important for efficacy, particularly in trauma and postpartum hemorrhage 6.
The optimal dose and mode of administration of TXA for gastrointestinal bleeding are still unclear and require further study.

The studies found no significant increase in thromboembolic events or other adverse effects with the use of TXA in gastrointestinal bleeding, except for an increased risk of venous thrombosis in patients with gastrointestinal bleeding 2, 6, 5.
Higher doses of TXA may increase the risk of seizures 6.
The risk of thromboembolic events and other adverse effects should be carefully considered when using TXA in patients with gastrointestinal bleeding.