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Inhaled Tranexamic Acid for Hemoptysis Treatment: A Randomized Controlled Trial.
Chest. 2018 Oct 12;:
Authors: Wand O, Guber E, Guber A, Epstein Shochet G, Israeli-Shani L, Shitrit D
Abstract
BACKGROUND: Tranexamic Acid (TA) is an antifibrinolytic drug currently used systemically to control bleeding. To date, there are no prospective studies of the effectiveness of inhaled TA for hemoptysis treatment.
OBJECTIVE: To prospectively assess the effectiveness of TA inhalations (i.e. nebulized TA) for hemoptysis treatment.
METHODS: We conducted a double-blind, randomized controlled trial of treatment with nebulize TA (500mg, three times daily) vs. placebo (Normal Saline (NS)) in patients admitted with hemoptysis of various etiologies. Patients with massive hemoptysis (expectorated blood >200ml/24Hrs), hemodynamic or respiratory instability were excluded. Mortality and hemoptysis recurrence rate were assessed at 30 days and following 1 year.
RESULTS: Forty seven patients were randomized to TA inhalations (n=25) or NS (n=22). TA was associated with a significantly reduced expectorated blood volume starting from the second day of admission. Hemoptysis resolution within 5 days from admission was observed in more TA treated patients than placebo (96% vs. 50%, p<0.0005). Mean hospital length of stay was shorter for the TA group (5.7±2.5 vs. 7.8±4.6 days, p=0.046), with less patients requiring invasive procedures, such as interventional bronchoscopy or angiographic embolization, to control the bleeding (none vs 18.2%, p=0.041). No side effects were noted in either group throughout the follow up period. In addition, a reduced recurrence rate was noted at the 1 year follow up (p=0.009).
CONCLUSIONS: TA inhalations can be used safely and effectively to control bleeding in patients with non-massive hemoptysis.
PMID: 30321510 [PubMed - as supplied by publisher]