tranexamic acid with acute gastrointestinal bleeding

 Q: Tranexamic acid can be used as an adjuvant treatment in patients with severe upper Gastrointestinal bleed (GIB)?

A) Yes

B) No

Answer: B

Tranexamic acid has been suggested as an adjuvant treatment in severe upper GIB due to its antifibrinolytic properties. After few initial studies showed some evidence of improvement in mortality,  a subsequent large RCT with 12,000 patients failed to show any benefit. Moreover, it carries a higher risk to cause deep vein thrombosis (DVT), pulmonary embolism (PE), and seizures.

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References:

1. Bennett C, Klingenberg SL, Langholz E, Gluud LL. Tranexamic acid for upper gastrointestinal bleeding. Cochrane Database Syst Rev 2014; :CD006640. 

2. HALT-IT Trial Collaborators. Effects of a high-dose 24-h infusion of tranexamic acid on death and thromboembolic events in patients with acute gastrointestinal bleeding (HALT-IT): an international randomised, double-blind, placebo-controlled trial. Lancet 2020; 395:1927.