TXA has been shown to improve outcomes in cases of bleeding including postpartum hemorrhage (WOMAN trial), trauma (CRASH-2 trial), epistaxis, oral bleeding and even inhaled TXA for hemoptysis (shout out to Dr Bogach for a recent case of this). It’s low rate of complications (remember its antifibrinolytic, NOT prothrombotic) makes it a great choice for controlling bleeding.
Given its success in controlling hemorrhage from these sources, there has been investigation into the use of TXA in other kinds of bleeding including ICH (TICH-2 trial showed promising but inconclusive results, needs to be streamlined) and TBI (CRASH-3 trial, ongoing). Gastrointestinal bleeding (GIB) is a
A Cochrane review on the use of TXA I'm GiB was conducted in 2012, which showed no change in transfusion needs, surgery or bleeding. Another systematic review was conducted in 2014 that showed a reduction in mortality but noted that several of the studies used had some design flaws. Additionally, the number of subjects in the combined studies was below the number needed to reliably find a significant result.
Currently, the Hemorrhage ALleviation with Transexamic acid - InTestinal system Trial or HALT-IT Trial in Great Britain (I would have gone with Patient Oriented Outcomes in GiB or Stop Hemorrhage In Intestinal Tract but it is what it is) is currently enrolling patients with a goal of 8000+ subjects by summer 2019. Treatment arm will consist of 1g IV bolus dose and then 3g IV over 24hrs (compared with CRASH-2 which gave 1g IV bolus with another 1g IV over the next 8hrs) with the control receiving NS. Currently, TXA is not included in current recommendations in the management of nonvariceal GIB. However, given its utility in other types of bleeding and it's low risk of complications, it could be considered in severe cases.
Summary: No evidence to support TXA in GIB but hopefully there will be some data coming out within the next year. Consider it in cases that are refractory to standard of care.
Would live to hear from anyone with experience with using TXA for GiBs.
The TRs