From the Guidelines
Tranexamic Acid (TXA) is not recommended as a standard treatment to stop a gastrointestinal (GI) bleed. The use of TXA in acute GI bleeding has been studied, and while some trials suggest a potential benefit in reducing mortality, the evidence is not strong enough to support its routine use 1. In fact, a large randomized controlled trial found no beneficial effect of TXA in patients with acute upper gastrointestinal bleeding, and an increased risk of venous thromboembolic events was observed 1.
- The European Society of Intensive Care Medicine suggests not using high-dose IV TXA in critically ill patients with gastrointestinal bleeding, due to high certainty of harms and no clear benefit 1.
- The optimal treatment for GI bleeding remains standard care, including endoscopic therapy, acid suppression, and supportive care.
- TXA may be considered in specific cases, such as postpartum hemorrhage, but its use in GI bleeding is not supported by strong evidence.
- The dose and duration of TXA treatment are not well established for GI bleeding, and its use should be individualized based on patient factors and clinical judgment.
From the Research
Tranexamic Acid (TXA) and Gastrointestinal (GI) Bleeding
- TXA is not effective in reducing bleeding in upper and lower gastrointestinal bleeding, as stated in the study 2.
- The study 2 highlights that TXA has beneficial effects in many clinical indications, but its use in GI bleeding is not supported by the evidence.
- There is no mention of TXA being effective in stopping GI bleeds in the other studies 3, 4, 5, 6.
- The primary focus of the other studies is on the use of TXA in trauma, surgical settings, and bleeding disorders, rather than GI bleeding specifically.
Safety and Efficacy of TXA
- The study 2 notes that TXA can cause harm, such as an increased risk of seizures and thrombotic events, particularly with certain dosages and indications.
- The study 3 reports an increased rate of venous thromboembolic events in patients receiving TXA, highlighting the need for careful consideration of the risks and benefits.
- The study 6 suggests that high-dose IV TXA may reduce transfusion requirements, but its effect on thromboembolic events and mortality is uncertain.
Clinical Use of TXA
- The study 5 emphasizes the importance of compliance with TXA administration guidelines in trauma patients, highlighting the need for quality improvement strategies.
- The study 4 demonstrates the potential benefits of TXA administration in adult combat trauma patients, with improved neurologic outcomes and reduced mortality.