Tranexamic acid may be a useful pharmacotherapy for endoscopically resistant small bowel angiodysplasia

Abstract

Small bowel angiodysplasia (SBAD) is reported to account for nearly 50% of cases of small bowel bleeding. When SBAD occurs frequently, it is difficult to treat all the angiodysplasias endoscopically, and gastrointestinal bleeding often recurs. Hormone therapy, somatostatin analogs, thalidomide and vascular endothelial growth factor (VEGF)-neutralizing antibodies have been reported to reduce gastrointestinal angiodysplasia (GIAD) bleeding. However, there is no strong evidence to recommend them. Also, there are no guidelines for their use. Hereditary hemorrhagic telangiectasia (HHT) is a hereditary disease caused by abnormalities in VEGF, resulting in multiple GIADs. A treatment guideline has been created for GIAD in HHT, and the use of tranexamic acid, an antifibrinolytic agent, is the first recommendation pharmacotherapy for GIAD with gastrointestinal bleeding that is difficult to treat endoscopically. It has been reported that fibrinolysis is accelerated in GIAD patients who are not HHT, similar to HHT patients. The use of tranexamic acid for gastric antral vascular ectasia in GIAD has been reported to be useful. However, there are very few reports of its use for SBAD. There are concerns with tranexamic acid use regarding the development of thrombosis/embolism, but there are few reports of such side effects. Future clinical trials including tranexamic acid for SBAD are desired.

Keywords: Angiodysplasia; Intestine; Hereditary hemorrhagic telangiectasia; Tranexamic acid; Endoscopic treatment; Pharmacotherapy

Core Tip: It is difficult to treat all multiple small bowel angiodysplasias (SBAD) endoscopically. Four main types of drugs, including somatostatin analogs, hormone therapy, thalidomide, and vascular endothelial growth factor-neutralizing antibodies, have been reported for use in gastrointestinal angiodysplasias (GIAD). However, there is no recommended pharmacotherapy for SBAD. Tranexamic acid is recommended for patients with GIAD in hereditary hemorrhagic telangiectasia who are difficult to treat endoscopically. Investigation of the use of tranexamic acid for SBAD is desired.