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 studied, but the evidence is not strong enough to support its use in clinical practice 1.
- A large randomized placebo-controlled trial of 12,009 patients with acute upper gastrointestinal bleeding found no beneficial effect of TXA in reducing mortality due to bleeding 1.
- In fact, the trial found an increased incidence of venous thromboembolic events in the TXA group, particularly in patients with comorbid liver disease or suspected variceal bleeding 1.
- The guidelines from the British Society of Gastroenterology suggest that the use of TXA in acute lower GI bleeding should be confined to clinical trials, pending the results of the HALT-IT trial 1.
- The EASL clinical practice guidelines recommend against the use of TXA in patients with cirrhosis and active variceal bleeding, citing a lack of benefit and potential harm 1.
- The potential risks of TXA, including thromboembolic events, outweigh any potential benefits in the context of GI bleeding, and its use should be avoided in clinical practice.
- The current evidence supports the use of other treatments, such as endoscopic therapy, vasoactive therapy, and antibiotics, to manage GI bleeding 1.
From the Research
Tranexamic Acid (TXA) and Gastrointestinal (GI) Bleeding
- The use of Tranexamic Acid (TXA) in stopping a gastrointestinal (GI) bleed is a topic of interest, with various studies investigating its effectiveness.
- A study published in the Lancet in 2020 2 found that TXA did not reduce death from gastrointestinal bleeding, and its use is not recommended outside the context of a randomized trial.
- Another study published in Cureus in 2020 3 noted that TXA has been shown to decrease mortality in trauma patients, but further studies are warranted for its use in gastrointestinal bleeding.
Effectiveness of TXA in GI Bleeding
- A review of the literature published in Thrombosis Journal in 2021 4 found that TXA was not effective in reducing bleeding in upper and lower gastrointestinal bleeding.
- The CRASH-2 trial, published in Health Technology Assessment in 2013 5, found that early administration of TXA reduced the risk of death due to bleeding in trauma patients, but its effectiveness in GI bleeding is still unclear.
Safety and Potential Risks
- The use of TXA has been associated with an increased risk of thrombotic events, particularly in patients with gastrointestinal bleeding and trauma 2, 4.
- A commentary published in Critical Care in 2012 6 hypothesized that TXA may have an antithrombotic effect, but further research is needed to confirm this.