From the Guidelines
Tranexamic acid (TXA) is not recommended as a standard treatment to stop a gastrointestinal (GI) bleed, due to limited and uncertain evidence of its benefit in this context [ 1, 1 ].
Key Considerations
- The use of TXA in acute GI bleeding has shown some promise in reducing mortality, with a 40% risk reduction in mortality in pooled analysis of several trials [ 1 ].
- However, this treatment benefit was no longer apparent when the analysis was limited to trials at low risk of bias [ 1 ].
- The European Society of Intensive Care Medicine suggests not using high-dose IV TXA in critically ill patients with gastrointestinal bleeding, based on high certainty evidence [ 1 ].
- The optimal dosing regimen for TXA in GI bleeding is uncertain, and its use is generally recommended to be confined to clinical trials, pending further evidence [ 1 ].
Clinical Implications
- In clinical practice, the use of TXA for GI bleeding should be approached with caution, and alternative treatments should be considered as first-line options.
- 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 latest available evidence.
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 its use in trauma, surgical procedures, and obstetric patients.
TXA Administration and Bleeding Control
- TXA has been shown to reduce bleeding in various surgical procedures and improve survival rates in obstetric and trauma patients with severe bleeding 5.
- The administration of TXA within 8 hours of injury has been shown to significantly reduce mortality in trauma patients 4.
- Prehospital administration of TXA may reduce early all-cause mortality in adult trauma patients when given within three hours of injury 6.
Safety and Efficacy of TXA
- TXA is generally well tolerated, and most adverse reactions are considered mild or moderate 5.
- High doses of TXA have been associated with seizures and other adverse effects 2, 5, and 6.
- The optimal dose and timing of TXA administration to minimize risks and maximize benefits are still being researched 2, 5, and 6.