Tranexamic acid inhibits the degradation of a newly formed fibrin clot. The drug reduces blood loss and transfusion requirements in a wide range of different clinical scenarios and patient settings. So far, tranexamic acid is not part of standard treatment among patients with gastrointestinal bleeding. This article evaluates the available literature on this topic. Tranexamic acid seems appropriate as adjuvant treatment during upper gastrointestinal bleeding. However, these patients are often old and have several co-morbidities. Therefore, thromboembolic risk and tranexamic acid dosage should be carefully evaluated.