2d • Paramedic Talk
No TXA for Esophageal varices?
Why TXA is generally NOT used in variceal hemorrhage
1. Variceal bleeding is a pressure problem, not a clotting problem
- Esophageal varices bleed due to portal hypertension
- The bleeding source is high-pressure venous flow
- TXA stabilizes clots, but it does not reduce portal pressure
- Without lowering pressure, clots are easily displaced and bleeding continues
2. Large clinical trials showed no benefit and possible harm
In major GI bleeding studies (including variceal bleeds):
- No reduction in mortality
- No reduction in rebleeding
- Higher risk of thromboembolic events (DVT, PE)
- Higher risk of seizures at higher doses
As a result, modern GI and hepatology guidelines do not recommend TXA for routine upper GI or variceal bleeding.
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No TXA for Esophageal varices?
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