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, and 6, which focus on trauma, traumatic brain injury, and postpartum hemorrhage.
TXA Administration and Bleeding Control
- TXA reduces bleeding in patients with menorrhagia, and in patients undergoing various surgical procedures, as mentioned in the study 2.
- The study 5 found that TXA reduces mortality among victims of severe traumatic bleeding when administered within one hour.
- The study 6 suggests that prehospital TXA administration may reduce early all-cause mortality in adult trauma patients when given within three hours of injury.
Safety and Efficacy of TXA
- The study 2 notes that TXA can cause harm, such as an increased risk of seizures after high TXA doses with brain injury and cardiac surgery.
- The study 3 found no significant differences in the number of thromboembolic events recorded between patients who received TXA and those who did not.
- The study 5 warns of a risk of convulsions linked to high intravenous doses of TXA, and cases of thrombosis have also been reported.