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Fibrinolytic activity in biopsied colonic mucosa was examined in patients with ulcerative colitis, and most cases were found to have increased tissue fibrinolysis -- due mainly to tissue plasminogen activator -- in the affected mucosa. Five cases, 4 with elevated tissue fibrinolysis and 1 normal, were treated with an antifibrinolytic agent, tranexamic acid (trans-AMCHA) administered as an enema, to inhibit fibrinolysis of the affected mucosa directly. In patients with elevated mucosal fibrinolysis, 2 showed complete remission after tranexamic acid enema alone, and there was one remission in response to combination treatment with oral prednisolone. One case with slightly elevated mucosal fibrinolysis showed clinical improvement, although the radiological findings were unchanged. No response was observed in one case with normal tissue fibrinolysis. It is concluded that tranexamic acid may show a therapeutic effect in ulcerative colitis with elevated mucosal fibrinolysis when administered via an enema, which allows direct contact of the drug with the affected mucosa.
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