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Inhaled Tranexamic Acid as an Alternative for Hemoptysis Treatment FREE TO VIEW

Gonzalo Segrelles Calvo; Ignacio De Granda-Orive; Daniel López Padilla
Author and Funding Information

FINANCIAL/NONFINANCIAL DISCLOSURES: None declared.

CORRESPONDENCE TO: Gonzalo Segrelles Calvo, Department of Pulmonology, Rey Juan Carlos Hospital, Av Gladiolo s/n, 28933 Móstoles, Madrid, Spain


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2016;149(2):604. doi:10.1016/j.chest.2015.10.016
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Tranexamic acid (TA) is an antifibrinolytic agent (synthetic lysine analog), which reversibly binds to plasminogen. It has been used in major surgery for bleeding control, although systemic effects such as thrombosis require rigorous monitoring. To date, there is no general consensus regarding TA doses or routes of administration. Similarly, there is insufficient evidence on what antifibrinolytic agent should be used when hemoptysis takes place. We present a series of cases in which inhaled TA was a feasible alternative for hemoptysis secondary to lung cancer or bronchiectasis.

Four male patients were admitted to the respiratory department for hemoptysis (Table 1), and the most frequent cause was lung cancer. TA was administered through a jet nebulizer with a flow rate of 5 L of oxygen per minute, and doses of 2.5 or 5 mL were prescribed according to clinical decision, using a concentration of 500 mg/5 mL. The average duration of nebulization was 15 min. In all patients, the bleeding was classified as moderate with a mean hemoptysis volume of 100 mL per day, without severe hypotension, tachycardia, or hypovolemic shock. Inhaled TA was used with acceptable control of bleeding and no incidence of systemic effects. As to local effects, one patient presented a bronchospasm after the third dose of TA, which was successfully treated with short-term bronchodilators.

Table Graphic Jump Location
Table 1 Clinical and Tranexamic Acid Treatment Features
a Bleeding time is the time between the start of TA and hemoptysis resolution.

BCH = bronchiectasis; TA = tranexamic acid.

Our findings are consistent with other studies that propose inhaled TA as an alternative for hemoptysis treatment, reducing bleeding time with no differences in systemic effects compared with a placebo., Ours is a small sample; hence, any conclusion should be regarded with caution, and more evidence is needed to support this type of treatment.

References

Levin E.G. .Santell L. .Osborn K.G. . The expression of endothelial tissue plasminogen activator in vivo: a function defined by vessel size and anatomic location. J Cell Sci. 1997;110:139-148 [PubMed]journal. [PubMed]
 
Kerk K. .Edwards P. .Shakur H. .Roberts I. . Effect of tranexamic acid on surgical bleeding: systematic review and cumulative meta-analysis. BMJ. 2012;344:e3054- [PubMed]journal. [CrossRef] [PubMed]
 
Prutsky G. .Domecq J.P. .Salazar C.A. .Accinelli R. . Antifibrinolytic therapy to reduce haemoptysis from any cause (Review). Cochrane Database Syst Rev. 2012;:CD008711- [PubMed]journal
 
Solomonov A. .Fruchter O. .Zuckerman T. .Brenner B. .Yigla M. . Pulmonary hemorrhage: a novel mode of therapy. Respir Med. 2009;103:1196-1200 [PubMed]journal. [CrossRef] [PubMed]
 

Figures

Tables

Table Graphic Jump Location
Table 1 Clinical and Tranexamic Acid Treatment Features
a Bleeding time is the time between the start of TA and hemoptysis resolution.

BCH = bronchiectasis; TA = tranexamic acid.

References

Levin E.G. .Santell L. .Osborn K.G. . The expression of endothelial tissue plasminogen activator in vivo: a function defined by vessel size and anatomic location. J Cell Sci. 1997;110:139-148 [PubMed]journal. [PubMed]
 
Kerk K. .Edwards P. .Shakur H. .Roberts I. . Effect of tranexamic acid on surgical bleeding: systematic review and cumulative meta-analysis. BMJ. 2012;344:e3054- [PubMed]journal. [CrossRef] [PubMed]
 
Prutsky G. .Domecq J.P. .Salazar C.A. .Accinelli R. . Antifibrinolytic therapy to reduce haemoptysis from any cause (Review). Cochrane Database Syst Rev. 2012;:CD008711- [PubMed]journal
 
Solomonov A. .Fruchter O. .Zuckerman T. .Brenner B. .Yigla M. . Pulmonary hemorrhage: a novel mode of therapy. Respir Med. 2009;103:1196-1200 [PubMed]journal. [CrossRef] [PubMed]
 
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