Can tranexamic acid (TXA) stop a gastrointestinal bleed?

From the Guidelines

Tranexamic acid (TXA) can potentially stop a gastrointestinal bleed, but its use is currently recommended to be confined to clinical trials due to uncertain benefits in modern day care [ 1 ].

Key Points to Consider

• There is some evidence to suggest that TXA may be beneficial in acute GI bleeding, with a pooled analysis of several trials showing a 40% risk reduction in mortality [ 1 ].
• However, this benefit was no longer apparent when the analysis was limited to trials at low risk of bias, and the studies were considered historic and prior to the routine use of high-dose acid suppression and endoscopic therapy [ 1 ].
• The optimal dosing regimen for TXA in GI bleeding is unclear, but it is often given intravenously, and the HALT-IT trial may provide more guidance on its use in the future [ 1 ].
• It is essential to weigh the potential benefits of TXA against the risk of thromboembolic events, although studies have been too small to assess this effect in the context of GI bleeding [ 1 ].
• In clinical practice, the use of TXA for GI bleeding should be approached with caution and considered on a case-by-case basis, taking into account the individual patient's risk factors and clinical context.

From the Research

Tranexamic Acid (TXA) and Gastrointestinal Bleeding

• TXA is not effective in reducing bleeding in upper and lower gastrointestinal bleeding, as stated in the study 2.
• The study 2 also mentions that some trials reported an increased rate of thrombotic complications with the use of TXA for gastrointestinal bleeding.
• Another study 3 notes that further studies are warranted for the use of TXA in gastrointestinal bleeding, indicating a lack of conclusive evidence for its effectiveness in this area.

TXA Efficacy in Other Bleeding Conditions

• TXA has been shown to reduce bleeding in various surgical procedures, such as orthopedic surgery, cardiac surgery, and obstetric surgery, as well as in patients with menorrhagia and trauma patients with bleeding 2, 3, 4.
• TXA has also been found to reduce mortality in patients suffering from trauma and postpartum hemorrhage 2, 3.

Safety and Administration of TXA

• The optimal dose and timing of TXA administration are still being researched, and high doses of TXA have been associated with adverse effects such as seizures 2, 4.
• TXA is generally well tolerated, but its administration needs to be standardized to minimize risks and ensure safety 4.