Tranexamic Acid in Gastrointestinal Bleeding

Efficacy and Safety

Earlier meta-analyses of small trials suggested potential benefit with a 40% risk reduction in mortality, but this treatment benefit disappeared when analysis was limited to trials with low risk of bias, as noted by the British Society of Gastroenterology 1, 2
Historical studies on tranexamic acid in upper GI bleeding were conducted before the routine use of high-dose acid suppression and endoscopic therapy, making their extrapolation to modern care uncertain, according to the British Society of Gastroenterology 2, 3

The British Society of Gastroenterology (2019) explicitly recommends that the use of tranexamic acid in acute lower gastrointestinal bleeding should be confined to clinical trials, due to the lack of evidence supporting its efficacy 1, 2, 3, 4
Despite its proven efficacy in trauma-related bleeding, the evidence does not support tranexamic acid use in GI bleeding, as stated by the British Society of Gastroenterology 2

Hospitals should have a GI bleeding lead and agreed pathways for management of acute GI bleeding, but these should not routinely include tranexamic acid, as recommended by the British Society of Gastroenterology 2, 3