Tranexamic Acid


Have you had any experience with the use of tranexamic acid in dialysis patients? My mother has G.I. bleeding issues which have not responded to
treatment (Argon Plasma Coagulation). She was switched to sodium citrate from heparin and that has had a beneficial effect but her hematocrit/hemoglobin levels continue to go slowly down and I am looking for pharmacological options. My understanding is that tranexamic acid
acculmulates in dialysis patients so I am assuming this means that there is an increased risk of thromboembolism. Is that correct? Also, is there a
way to know to what extent it has accumulated (i.e.-does it reflect in any blood lab results). Thank you.

There have been a small number of reports in the literature of the use of Tranexamic Acid (TXA) as an adjunctive therapy in the treatment of major upper gastrointestinal bleeding in dialysis patients. One of these, from Slovenia, reported 20 consecutive patients where TXA was used with apparently beneficial results. However, Hedges et al, from Dallas, corresponded on this issue in Nature Clinical Practice Nephrology in 2007 and disagreed. They contended that the available evidence showed TXA to be no more effective than the more commonly used approaches from the treatment of upper gastrointestinal bleeding.

I have no personal experience with the use of TXA, and nor do any of my colleagues here. All I can say is that it has been used but that reputable services elsewhere have expressed reservations about its effectiveness. I am aware that upper gastrointestinal bleeding, particularly from angiodysplastic lesions or from conditions like ‘watermelon stomach’, can be particularly difficult to treat and are most distressing for the patient. However, with no personal experience and a paucity of literature to support its widespread adoption, it is not a direction I would be taking without a whole lot more knowledge than I currently possess on the subject.

Unfortunately, there is little more that I can say to help you and I know that on this occasion I have not been particularly helpful – but this is an issue on which I really have insufficient experience to make sensible comment. Your team +/- a gastroenterologist with knowledge and experience on TXA use are likely better placed to advise you wisely. I will leave this for you to further discuss with them.

John Agar