Can tranexamic acid (TXA) stop a gastrointestinal (GI) bleed?

From the Guidelines

Tranexamic acid (TXA) may be beneficial in stopping a GI bleed, particularly for upper GI bleeds, but its effectiveness for lower GI bleeds is uncertain and should be used with caution. TXA works by inhibiting the breakdown of blood clots, which helps control bleeding. According to the British Society of Gastroenterology guidelines 1, several trials of tranexamic acid in upper GI bleeding have shown a 40% risk reduction in mortality. However, this treatment benefit for mortality was no longer apparent when the analysis was limited to trials at low risk of bias. For patients with hereditary hemorrhagic telangiectasia, TXA is recommended for those with mild GI bleeding due to its low potential for harm, but there is limited evidence of effectiveness 1.

Key Considerations

• TXA appears most beneficial for upper GI bleeds rather than lower GI bleeds
• TXA works best when used alongside other treatments like proton pump inhibitors, endoscopic therapy, or correction of coagulopathies
• The medication is particularly useful in situations where endoscopy might be delayed or unavailable
• TXA's mechanism involves blocking lysine binding sites on plasminogen, preventing its conversion to plasmin and thus inhibiting fibrinolysis (the breakdown of blood clots)
• While TXA can help reduce rebleeding rates and the need for surgical intervention, it should be used cautiously in patients with thromboembolic risk factors, as it may potentially increase clotting risk elsewhere in the body

Treatment Approach

• For upper GI bleeds, TXA is typically administered at a dose of 1g intravenously every 6-8 hours, or 1-1.5g orally three to four times daily
• Treatment duration usually ranges from 3-7 days depending on bleeding control
• TXA should be used in conjunction with other treatments and under close monitoring, especially in patients with thromboembolic risk factors 1

From the Research

Efficacy of Tranexamic Acid in GI Bleeding

• Tranexamic acid (TXA) has been studied as a potential treatment for acute gastrointestinal (GI) bleeding, with evidence suggesting its effectiveness in reducing rebleeding rates and mortality in certain cases 2, 3, 4, 5.
• A systematic review and meta-analysis found that TXA significantly reduced the rates of continued bleeding, urgent endoscopic intervention, and mortality compared to placebo 3.
• Another study found that TXA reduced the need for urgent endoscopy and improved outcomes for patients with acute GI bleeding 2.

Reduction in Mortality and Rebleeding

• TXA has been shown to reduce mortality in patients with upper GI bleeding, with a relative risk (RR) of 0.72 (95% CI: 0.59-0.87) 5.
• A meta-analysis found that TXA significantly reduced rebleeding rates overall, with an RR of 0.81 (95% CI: 0.87-0.97) 5.
• TXA has also been found to reduce the need for surgical intervention in patients with GI bleeding, particularly in those with upper GI bleeding 5.

Safety and Adverse Events

• The use of TXA has been associated with an increased risk of thromboembolic events, including deep venous thrombosis and pulmonary embolism 6.
• However, other studies have found no significant increase in thromboembolic events with TXA use 3, 4, 5.
• The overall safety profile of TXA in patients with GI bleeding is still being studied, and more research is needed to fully understand its risks and benefits 6, 5.

Clinical Applications

• TXA may be a useful adjunctive treatment for patients with acute GI bleeding, particularly those with upper GI bleeding 2, 3, 5.
• The use of TXA should be individualized and based on patient-specific factors, including the severity of bleeding and the presence of comorbidities 5.
• Further research is needed to fully understand the efficacy and safety of TXA in patients with GI bleeding, particularly in those with lower GI bleeding 6, 5.