BSG/ACPGBI Advise Against Routine Tranexamic Acid in GI Bleeding : Frontline Gastroenterol | May 2026

Introduction

Tranexamic acid has been widely used across trauma, surgical and hemorrhagic settings because of its antifibrinolytic effects and ability to stabilize clot formation. Earlier small studies suggested potential benefit in gastrointestinal bleeding, leading to interest in its use for acute upper and lower GI hemorrhage.

Problem Statement

Despite historical enthusiasm, uncertainty remained regarding the efficacy and safety of tranexamic acid in gastrointestinal bleeding, particularly in the era of modern endoscopic hemostasis, proton-pump inhibitors and contemporary supportive care. Clarification from major societies was required following publication of high-quality randomized evidence.

Summary

This position statement from the British Society of Gastroenterology and Association of Coloproctology of Great Britain and Ireland strongly advises against the routine use of tranexamic acid in acute upper or lower gastrointestinal bleeding. The recommendation is primarily based on the landmark HALT-IT trial, a large international randomized placebo-controlled study involving more than 12,000 patients with significant GI bleeding. HALT-IT demonstrated no reduction in bleeding-related mortality with tranexamic acid administration despite earlier smaller studies suggesting possible benefit. Importantly, the trial identified increased risks of venous thromboembolism and seizures among patients receiving tranexamic acid, raising significant safety concerns. The societies emphasize that earlier positive studies were methodologically weak and conducted before widespread use of modern endoscopic therapy and optimized acid suppression. Consequently, the position statement concludes that the overall risk–benefit profile does not support routine TXA use in GI bleeding. The document further states that any exceptionally rare off-guideline use should occur only after exhaustion of standard therapies, require senior consultant-level decision-making and be clearly documented within institutional governance systems. This statement is clinically important because tranexamic acid continues to be intermittently used in GI bleeding despite robust negative evidence. The guidance reinforces evidence-based deimplementation of ineffective interventions and highlights the importance of avoiding therapies associated with potential thrombotic harm in already vulnerable bleeding populations.