Nebulized Tranexamic Acid for Hemoptysis

Veerle Leenaerts*

Nebulized Tranexamic Acid for Hemoptysis

Hemoptysis is a common symptom in the emergency department. It is defined
as the expectoration of blood originating from the tracheobronchial tree or lung parenchyma.

It is a symptom of diverse respiratory diseases such as lung cancer, infections
and vasculitis. The severity can vary, ranging from immediate life-threatening hemorrhage
to minimal blood-streaked sputum.

Treatment options are diverse and mostly based on the underling disease,
for example radiotherapy for bronchial carcinoma, immunosuppressive for vasculitis
or antibiotics for infections.

For massive hemoptysis, interventional procedures such as angiographic
bronchial artery embolization and various endobronchial interventions are used.

Tranexamic acid is a cheap, synthetic drug with anti-fibrinolytic activity based
on inhibiting the activation of plasminogen.

It is especially used intravenously, orally and topically to prevent and treat
various bleeding complications, but only a few studies have investigated the effect
of tranexamic acid as an inhalation drug for hemoptysis.

In this review, the available literature about aerosolized tranexamic acid
for both massive and non-massive hemoptysis is listed. resolution of the bleeding
after administration of nebulized tranexamic acid in patients of very different ages with varying
underlying etiologies of the massive hemoptysis.

Table 2 shows the available literature about nebulized tranexamic acid in non-massive hemoptysis.
Calvo et al11 showed in a case series of 4 males with moderate hemoptysis due to lung
cancer or bronchiectasis that bleeding stopped after inhalation of tranexamic acid.

Moreover there was no need for invasive procedures in the tranexamic acid group while
18.2% of patients required angiography or bronchoscopy in the normal saline group.

Emerg Med Open J. 2020; 6(1): 6-8. doi: 10.17140/EMOJ-6-156