From the Guidelines
Tranexamic acid (TXA) should not be used to stop a gastrointestinal (GI) bleed, as the current evidence does not support its effectiveness in this context [ 1 ].
Key Points
- The use of TXA in acute GI bleeding has been evaluated in several studies, but the results are inconsistent and often limited by high risk of bias [ 1 ].
- A large randomized controlled trial found no beneficial effect of TXA in patients with acute upper GI bleeding, and actually reported an increased risk of venous thromboembolic events [ 1 ].
- The European Society of Intensive Care Medicine suggests not using high-dose IV TXA in critically ill patients with GI bleeding, citing high certainty evidence [ 1 ].
- The optimal management of GI bleeding involves a multifaceted approach, including endoscopic therapy, acid suppression, and supportive care, but TXA is not a recommended adjunctive treatment [ 1 ].
Clinical Considerations
- The decision to use TXA in GI bleeding should be made on a case-by-case basis, taking into account individual patient factors and the underlying cause of the bleeding.
- Clinicians should be aware of the potential risks and benefits of TXA in this context and carefully weigh the evidence before making a decision.
- Further research is needed to fully understand the role of TXA in GI bleeding and to inform evidence-based practice guidelines.
From the Research
Efficacy of Tranexamic Acid in GI Bleed
- Tranexamic acid (TXA) has been studied for its effectiveness in various bleeding conditions, including gastrointestinal (GI) bleeding 2, 3.
- However, the evidence suggests that TXA is not effective in reducing bleeding in upper and lower GI bleeding 2.
- One study found that TXA was associated with an increased rate of thrombotic complications when used for GI bleeding 2.
- Another study noted that further research is needed to determine the efficacy and safety of TXA in GI bleeding 3.
Safety and Efficacy in Other Bleeding Conditions
- TXA has been shown to reduce mortality in patients with trauma and postpartum hemorrhage 2, 4.
- It is also effective in reducing bleeding in patients undergoing various surgical procedures, such as orthopedic, cardiac, and prostate surgery 2.
- However, the optimal dose and timing of TXA administration are still being studied, and high doses have been associated with an increased risk of seizures and thrombotic events 2, 5.
Clinical Use and Administration
- TXA is widely used in trauma centers to manage patients with major bleeding, but compliance with administration protocols can be low 6.
- Early administration of TXA, within 1 hour of injury, has been shown to reduce mortality in trauma patients 4.
- However, the risk of thrombosis and other complications, such as convulsions, must be carefully considered when administering TXA 5, 4.