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 availability of other treatment options.
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, surgery, and other indications.
TXA Efficacy and Safety
- The efficacy of TXA in reducing bleeding and mortality has been established in certain clinical settings, such as trauma and postpartum hemorrhage 2, 3, and 6.
- However, the safety of TXA, particularly with regards to thrombotic complications and seizures, is a concern and requires further study 2, 4, and 5.
- The optimal dose and timing of TXA administration to minimize risks and maximize benefits are still being researched and debated 2, 4, and 5.