First10EM - By Justin Morgenstern - March 9, 2020
"Bottom line for TXA in GI bleeds
Small trials with high risk of bias leave us unsure. The Cochrane review says “this review found no evidence that tranexamic acid offers benefit to patients with upper gastrointestinal bleeding, in terms of mortality, bleeding, surgery, or transfusion requirements.” However, their results do show a statistical significant reduction in mortality. (Bennett 2014) Hopefully the large RCT currently underway will settle the issue.
Given the potential reduction in mortality, if you have an IV free and it won’t delay more important therapies, I think giving a bolus of TXA while waiting for definitive management is completely reasonable. However, I also won’t be surprised when the HALT-IT trial is negative (and then we have a another big debate about the meaning of secondary outcomes)."