From the Guidelines
Tranexamic acid (TXA) can be used to help stop a lower gastrointestinal (GI) bleed, but its effectiveness is still being studied and the optimal dosing regimen has not been established 1.
Key Considerations
- The use of TXA in acute lower GI bleeding is currently recommended to be confined to clinical trials, pending the results of the HALT-IT trial 1.
- For patients with mild GI bleeding, TXA may be considered due to its low potential for harm, although there is limited evidence of effectiveness 1.
- In cases of moderate or severe GI bleeding, systemic bevacizumab is recommended over TXA due to its substantial improvements in mean hemoglobin and reduction in red cell transfusions 1.
- The European Society of Intensive Care Medicine suggests not using high-dose IV TXA in critically ill patients with gastrointestinal bleeding, but makes no recommendation regarding the use of low-dose IV TXA or enteral TXA 1.
Dosing Regimen
A dose of 1 gram of TXA orally or intravenously every 8 hours for a duration of 3-5 days may be considered to help stabilize the bleeding, although the optimal dosing regimen has not been established. In cases of severe bleeding, higher doses of up to 2 grams every 8 hours may be used, but with caution and careful monitoring due to the potential for thromboembolic events 1.
Important Notes
- TXA should be used with caution in patients with a history of thrombosis or thrombophilia, and its use should be carefully weighed against the potential benefits and risks 1.
- The use of TXA in lower GI bleeding should be individualized and based on the specific clinical context, taking into account the severity of the bleeding, the patient's underlying medical conditions, and the potential risks and benefits of treatment 1.
From the Research
Tranexamic Acid (TXA) and Lower GI Bleed
- TXA is an antifibrinolytic agent that has been shown to reduce blood loss in various clinical conditions, but its effectiveness in treating lower GI hemorrhage is still being studied 2, 3.
- A randomized placebo-controlled clinical trial found that TXA did not decrease blood loss or improve clinical outcomes in patients presenting with lower GI hemorrhage 3.
- Another study reviewed the evidence for TXA in the treatment and prevention of bleeding caused by surgery, trauma, and bleeding disorders, and found that TXA was not effective in reducing bleeding in lower gastrointestinal bleeding 2.
- There is no consensus about the optimal TXA dose for many indications, and certain dosages and indications may cause harm, such as an increased risk of seizures or thromboembolic events 2, 4.
Clinical Trials and Studies
- A prospective, double-blind, placebo-controlled, randomized clinical trial of 100 patients with lower GI hemorrhage found no difference between TXA and placebo groups in terms of hemoglobin drop, transfusion rates, or clinical outcomes 3.
- A narrative review of the evidence for TXA in the treatment and prevention of bleeding caused by surgery, trauma, and bleeding disorders found that TXA has well-documented beneficial effects in many clinical indications, but its use in lower GI bleeding is not supported by the evidence 2.
- A study on the compliance of TXA administration to trauma patients at a level-one trauma centre found that compliance was low, and quality improvement strategies are needed to increase appropriate use of TXA 5.
Safety and Efficacy
- TXA has been shown to be safe and effective in reducing mortality and blood loss in trauma patients with bleeding, but its use in lower GI bleeding is not supported by the evidence 2, 4.
- High-dose TXA has been shown to be beneficial in reducing blood loss during surgery for adolescent idiopathic scoliosis, but optimal dosing for lower GI bleeding has not been defined 6.
- Further studies are warranted to determine the therapeutic efficacy and safety of TXA in gastrointestinal bleeding and pediatric trauma 4.