Am J Emerg Med

IV tranexamic acid reduces rebleeding but not mortality in patients with GI bleeds

September 4, 2025

IV tranexamic acid (TXA) may be considered as adjunctive therapy to reduce rebleeding and failure to control bleeding in GI hemorrhage, but it doesn't confer a mortality benefit and may increase thromboembolic risk.

Study details: This systematic review and meta-analysis (PRISMA-guided) included 7 randomized trials with a total of 13,608 adult patients presenting with GI bleeding. The analysis focused on IV TXA vs. placebo or standard care, evaluating outcomes such as mortality, rebleeding, failure to control bleeding, thromboembolic events, and transfusion requirements.

Results: IV TXA significantly reduced rebleeding rates (odds ratio [OR], 0.64; 95% confidence interval [CI], 0.45–0.91; P = 0.01) and failure to control bleeding (OR, 0.55; 95% CI, 0.45–0.91; P = 0.03). There was no significant reduction in mortality (OR, 0.77; 95% CI, 0.56–1.07; P = 0.12) or blood transfusion requirements (OR, 0.94; 95% CI, 0.61–1.43; P = 0.76). Thromboembolic risk was not significantly increased in the random-effects model (OR, 1.28; 95% CI, 0.51–4.51; P = 0.46), but fixed-effect analysis suggested a possible increase (OR, 1.28; 95% CI, 1.07–1.55; P = 0.009).

Source:

Djoudjou T, et al. (2025, July 23). Am J Emerg Med. Intravenous tranexamic acid in gastrointestinal bleeding: A systematic review and meta-analysis of randomized controlled trials. https://pubmed.ncbi.nlm.nih.gov/40752050/