Tranexamic Acid Is Ineffective for Acute Gastrointestinal Bleeding

A large randomized, controlled trial shows no mortality reduction and excess venous thromboembolism.

Tranexamic acid inhibits fibrinolysis and is used to reduce bleeding in trauma, surgery, and postpartum settings. Limited evidence suggests a possible benefit for treating gastrointestinal (GI) bleeding but also a possible increased risk for thromboembolic adverse events.

Researchers now present results of an international, randomized, double-blind, placebo-controlled trial of tranexamic acid in patients with GI bleeding (upper variceal, upper nonvariceal, and lower). The study treatment was an intravenous loading dose of 1 g tranexamic acid followed by a 3-g infusion over 24 hours.

Among 12,000 patients randomized, the primary outcome of death within 5 days due to bleeding occurred in 4% in each group. Although the rate of arterial thromboem…

Reviewing Author

John R. Saltzman, MD

Disclosures

Consultant/Advisory BoardIterative Scopes

Editorial BoardsGastrointestinal Endoscopy; UpToDate

Leadership Positions in Professional SocietiesAmerican College of Gastroenterology (Trustee)

OtherVice President of Medical Affairs, 1Globe Health Institute