Can Tranexamic acid (TXA) stop a lower gastrointestinal (GI) bleed?

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

Effectiveness of Tranexamic Acid in Lower GI Bleed

• The study 2 found that TXA was not effective in reducing bleeding in lower gastrointestinal bleeding.
• However, the study 3 suggested that when considered in the context of other evidence, a reduction in the risk of death from TXA in GI bleeding cannot be discounted.
• The studies 4, 5, and 6 do not provide direct evidence on the effectiveness of TXA in lower GI bleed, but they discuss the use of TXA in various clinical settings, including trauma patients and surgical bleeding.

Safety and Efficacy of TXA

• The study 2 highlights that TXA can cause harm, such as an increased risk of seizures and thrombotic events, with certain dosages and indications.
• The study 3 found that TXA did not increase the odds of vascular occlusive events (VOEs) and reduced the odds of death by 16% in patients with bleeding.
• The studies 5 and 6 note that TXA has been shown to decrease mortality and reduce blood loss after trauma or surgery, with good safety parameters upon administration.

Clinical Indications for TXA

• The study 6 provides an overview of the clinical indications for TXA in medical and surgical patients, including postpartum hemorrhage, menorrhagia, trauma-associated hemorrhage, and surgical bleeding.
• The study 2 discusses the therapeutic areas where evidence is lacking for TXA, including upper and lower gastrointestinal bleeding.
• The study 3 suggests that further research is needed to fully understand the role of TXA in GI bleeding.