Does Inhaled Tranexamic Acid Reduce Morbidity in Adult Patients with Hemoptysis?
Date First Published:
July 3, 2019
Last Updated:
July 3, 2019
Report by:
Jennifer Mervau DO, Jason Seamon DO, EM Senior Resident, EM Faculty (Spectrum Health/Michigan State University Emergency Medicine Residency Program)
Search checked by:
Jeffrey S. Jones, MD, Spectrum Health/Michigan State University Emergency Medicine Residency Program
Three-Part Question:
In [adults presenting with acute hemoptysis], is [inhaled tranexamic acid compared to placebo], more effective in [controlling bleeding]?
Clinical Scenario:
A 70-year-old man with a 60-pack year history with known lung cancer presents to the Emergency Department with hemoptysis that started 3 days ago. Hemoptysis was initially intermittent but has now become more persistent. Patient is hemodynamically stable. The pulmonologist on-call suggests trying inhaled tranexamic acid to control bleeding.
Search Strategy:
Medline 1966-07/19 using PubMed, Cochrane Library (2019), and Embase
Search Details:
[(exp tranexamic acid) AND (exp hemoptysis)]. Limit to English language.
Outcome:
34 studies were identified; one addressed the clinical question.
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Inhaled Tranexamic Acid for Hemoptysis Treatment: A Randomized Controlled Trial. Wand O, Guber E, Guber A, Epstein Shochet G, Israeli-Shani L, Shitrit D Dec-18 Israel | Adult patients (>18 years old) admitted with hemoptysis over previous 24 hours | RCT | Rate of complete resolution of hemoptysis during first 5 days from admission | 96% of patients who received inhaled TXA had complete resolution of hemoptysis within 5 days of admission vs 50% in the placebo group (p<0.0005) | Massive hemoptysis patients were excluded, small sample size, unable to perform subgroup analysis secondary to small sample size, exact time to resolution is not given, hemodynamic and respiratory instability not clearly defined |
| Difference in daily volume of expectorated blood. | Quantity of expectorated blood was significantly reduced by day 2 of admission |
Author Commentary:
Tranexamic acid is a synthetic derivative of the amino acid lysine that exerts its antifibrinolytic effect through the reversible blockade of lysine binding sites on plasminogen molecules. Intravenously administered tranexamic acid has been shown to reduce bleeding in patients with hemoptysis when compared with placebo. Now, one small RCT provides evidence that nebulized tranexamic acid (500 mg tid) may also be an effective and safe option for patients with nonmassive hemoptysis. It can be used as a sole therapy, or as an adjunct to other interventions in patients with hemoptysis of various causes.
Bottom Line:
In patients with non-massive hemoptysis, management with nebulized TXA may lead to faster resolution of hemoptysis, reduction of invasive procedures, shorter hospital length of stay.
References:
- Wand O, Guber E, Guber A, Epstein Shochet G, Israeli-Shani L, Shitrit D. Inhaled Tranexamic Acid for Hemoptysis Treatment: A Randomized Controlled Trial.