SP 1.11 A Systematic Literature Review of Tranexamic Acid in Lower Gastrointestinal Bleeding
Zeneera Yusuf, Yasuko MaedaAbstract
Aims
Tranexamic acid (TXA) is an antifibrinolytic agent used prophylactically and therapeutically for bleeding in diverse settings, including postpartum haemorrhage, trauma and perioperative bleeding, with variable efficacy across indications. This review aimed to assess the effectiveness of TXA in lower gastrointestinal bleeding (LGIB).
Methods
A systematic literature review was performed using a predefined protocol for guideline scoping after the clinical question, “Does tranexamic acid improve outcomes in lower gastrointestinal bleeding?”, was framed using the PICO format. MEDLINE and Embase were searched from database inception (1964) to August 2025. Outcomes of interest included mortality, thromboembolic events and blood transfusion requirements.
Results
A total of 259 titles were identified. Following screening using predefined inclusion and exclusion criteria, three randomised controlled trials (RCTs) and one large propensity-matched observational study were included, comprising 79,802 patients, of whom 30,849 received TXA. Mortality data were available from three studies. In two RCTs, TXA showed no mortality benefit compared with placebo (12/723 [1.7%] vs 7/701 [1.0%]; risk ratio 1.61, 95% CI 0.59–4.42). The observational study also showed no difference between TXA and control groups (0.7% vs 0.7%). No statistically significant differences were observed in thromboembolic events (two RCTs: 1.4% vs 1.2%) or transfusion requirements (two RCTs: 68.4% vs 69.0%; observational study: 31.4% vs 34.3%).
Conclusions
Current evidence does not demonstrate a mortality benefit of tranexamic acid in lower gastrointestinal bleeding, with no significant effect on thromboembolic risk or transfusion requirements.