A recent study in AJEM reviewed the utility of TXA in GI bleeding

This is a PRISMA?guided systematic review and meta?analysis of 7 RCTs (13,608 adults, 1976–2024) evaluating IV TXA vs placebo in acute gastrointestinal bleeding, including upper and mixed GI sources across multiple countries. The largest contributor is HALT?IT (Roberts et al.), which accounts for nearly 90% of participants.

-Mortality: No statistically significant reduction in all?cause mortality with TXA (OR 0.77; 95% CI 0.56–1.07, P = 0.12).?

-Rebleeding: TXA significantly reduced rebleeding events (OR 0.64; 95% CI 0.45–0.91, P = 0.01).?

-"Failure to control" bleeding: TXA reduced failure of hemostasis (OR 0.55; 95% CI 0.32–0.93, P = 0.03).

-Thromboembolic events: Random?effects model showed no significant difference (OR 1.28; 95% CI 0.51–4.51, P = 0.46), but fixed?effect analysis suggested a statistically significant increase (OR 1.28; 95% CI 1.07–1.55, P = 0.009), highlighting a possible thrombotic signal.?

-Transfusion and LOS: No significant reduction in blood transfusion requirements with TXA (OR 0.94; 95% CI 0.61–1.43, P = 0.76); length of stay and other resource metrics were variably reported and not clearly improved.

Take-Aways:

TXA may be reasonable as an adjunct in GI bleeding when the goal is to reduce rebleeding or “failure to control” bleeding, but current evidence does not support it as a mortality?reducing therapy.?

Given a potential increased risk of thromboembolic events, TXA should be used cautiously in patients with high baseline thrombotic risk, and always as part of a broader package including resuscitation and timely endoscopy rather than as a standalone intervention.

References

Djoudjou T, Alamri O, Aljuwayr A, et al. Intravenous tranexamic acid in gastrointestinal bleeding: A systematic review and meta-analysis of randomized controlled trials. Am J Emerg Med. 2025;97:175-182. doi:10.1016/j.ajem.2025.07.050