BACKGROUND: Tranexamic acid (TA) is a synthetic antifibrinolytic substance used for short-term control of bleeding. However, control of pulmonary bleeding with endobronchial administration of TA in more than 2 cases has not been attempted earlier. OBJECTIVE: We tested the feasibility of endobronchial administration of TA for controlling pulmonary bleeding. METHODS: This was a 2-year prospective observational trial of endobronchial TA in consecutive patients presenting with hemoptysis to our bronchoscopy unit. Patients were initially treated according to the recommendations of the Spanish National Guidelines using ice-cold saline and adrenaline. Endobronchial administration of TA was attempted in patients with uncontrolled hemoptysis before proceeding with further interventions (balloon occlusion or embolization). RESULTS: Forty-eight patients (37 male; mean age: 64±13 y) were treated with endobronchial TA. The causes of bleeding were divided into iatrogenic (n=28) and noniatrogenic (n=20). Among patients with noniatrogenic bleeding, malignancies (11 patients) and bronchiectasis (10 patients) were the most frequent causes of hemoptysis. In this patient group, endobronchial TA successfully controlled the bleeding in 11 subjects (39.2%). Nonresponders to endobronchial TA suffered more frequently from bronchiectasis (58.3% vs. 18.8%, P=0.039) and less frequently from malignancies (16.7% vs. 56.3%, P=0.040) as compared with responders. All patients with iatrogenic bleeding were treated successfully with endobronchial TA. No subject in either of the patient groups suffered from thrombotic events or other adverse events related to endobronchial TA administration. CONCLUSIONS: Patients with acute pulmonary bleeding may benefit from endobronchial instillation of TA. Further double-blinded controlled studies are necessary to confirm our results.
BACKGROUND:Tranexamic acid (TA) is a synthetic antifibrinolytic substance used for short-term control of bleeding. However, control of pulmonary bleeding with endobronchial administration of TA in more than 2 cases has not been attempted earlier. OBJECTIVE: We tested the feasibility of endobronchial administration of TA for controlling pulmonary bleeding. METHODS: This was a 2-year prospective observational trial of endobronchial TA in consecutive patients presenting with hemoptysis to our bronchoscopy unit. Patients were initially treated according to the recommendations of the Spanish National Guidelines using ice-cold saline and adrenaline. Endobronchial administration of TA was attempted in patients with uncontrolled hemoptysis before proceeding with further interventions (balloon occlusion or embolization). RESULTS: Forty-eight patients (37 male; mean age: 64±13 y) were treated with endobronchial TA. The causes of bleeding were divided into iatrogenic (n=28) and noniatrogenic (n=20). Among patients with noniatrogenic bleeding, malignancies (11 patients) and bronchiectasis (10 patients) were the most frequent causes of hemoptysis. In this patient group, endobronchial TA successfully controlled the bleeding in 11 subjects (39.2%). Nonresponders to endobronchial TA suffered more frequently from bronchiectasis (58.3% vs. 18.8%, P=0.039) and less frequently from malignancies (16.7% vs. 56.3%, P=0.040) as compared with responders. All patients with iatrogenic bleeding were treated successfully with endobronchial TA. No subject in either of the patient groups suffered from thrombotic events or other adverse events related to endobronchial TA administration. CONCLUSIONS:Patients with acute pulmonary bleeding may benefit from endobronchial instillation of TA. Further double-blinded controlled studies are necessary to confirm our results.
Authors: Shantanu Warhadapande; Sean R Dariushnia; Nima Kokabi; William G O'Connell; Janice M Newsome; Laura K Findeiss; Bill S Majdalany Journal: Semin Intervent Radiol Date: 2020-03-04 Impact factor: 1.513
Authors: Steffi Sunny; George Cheng; Daniel Daniel; Peter Lo; Sebastian Ochoa; Caitlin Howell; Nicolas Vogel; Adnan Majid; Joanna Aizenberg Journal: Proc Natl Acad Sci U S A Date: 2016-09-29 Impact factor: 11.205
Authors: Russell P Simon; Clara Oromendia; Lourdes M Sanso; Liz G Ramos; Kapil Rajwani Journal: Pulm Pharmacol Ther Date: 2019-11-26 Impact factor: 3.410
Authors: Maurizio Bernasconi; Coenraad F N Koegelenberg; Angela Koutsokera; Adam Ogna; Alessio Casutt; Laurent Nicod; Alban Lovis Journal: ERJ Open Res Date: 2017-06-21
Authors: Or Kalchiem-Dekel; Aldo Iacono; Edward M Pickering; Ashutosh Sachdeva; Nirav G Shah; Mark Sperry; Bich-Chieu Tran; Robert M Reed Journal: BMJ Open Date: 2019-03-23 Impact factor: 2.692