SP 1.14 Tranexamic Acid in Acute Lower Gastrointestinal Bleeding: A Systematic Review and Meta-analysis of Randomized Evidence
Nauman Ahmed, Shadab AliAbstract
Aims
To determine whether tranexamic acid (TXA) improves clinical outcomes or causes harm in patients presenting with acute lower gastrointestinal bleeding (LGIB).
Methods
A systematic review was conducted of PubMed, Embase, Web of Science, CENTRAL, CINAHL, and Google Scholar from inception to August 2025. Randomized controlled trials (RCTs) and observational cohort studies evaluating TXA in LGIB were included. Primary outcome was 28–30-day mortality. Secondary outcomes included rebleeding, transfusion requirements, need for surgical or radiological intervention, and adverse events. Risk of bias was assessed using RoB 2 and ROBINS-I. Random-effects meta-analysis was performed, reporting risk ratios (RR) or mean differences (MD) with 95% confidence intervals (CI).
Results
Five studies met inclusion criteria: three RCTs (≈12,200 patients, including the LGIB subgroup of HALT-IT) and two observational cohorts (≈16,500 patients). TXA did not reduce mortality (RR 0.95, 95% CI 0.72–1.25), rebleeding (RR 1.02, 95% CI 0.76–1.38), or transfusion requirements (MD −0.1 units, 95% CI −0.5 to +0.3). No reduction was observed in the need for surgical or radiological intervention. Safety analyses identified a signal toward increased venous thromboembolism and seizures, particularly with high-dose regimens.
Conclusions
Tranexamic acid provides no clinical benefit in acute lower gastrointestinal bleeding and may be associated with harm. These findings do not support routine TXA use in LGIB. Future research should prioritise adequately powered, LGIB-specific randomized trials rather than extrapolation from mixed gastrointestinal bleeding populations.