Mary Kovacevic, PharmD, BCCCP, BCPS

She/Her/Hers
Clinical Pharmacy Scientist
Medicine
Pulmonary and Critical Care Medicine
Efficacy of Nebulized Tranexamic Acid for Severe Hemoptysis at a Tertiary Academic Medical Center

Principal Investigator: Mary Kovacevic, PharmD, BCCCP, BCPS

Authors: Mary Kovacevic PharmD, BCCCP, BCPS Afrah Alkazemi, MS, PharmD, BCPS Kevin Dube, PharmD, BCCCP, BCPS Julie C. Lauffenburger, PharmD, PhD Adam Smith, BS, RRT-ACCS Stephen Malinowski, RRT Gerald L. Weinhouse, MD
Lay Abstract

Objective: The purpose of this study was to evaluate the effectiveness of inhaled or nebulized tranexamic acid (TXA) as treatment for hemoptysis or coughing up blood from the respiratory tract.

Methods: This study compared patients who received TXA for hemoptysis to patients who did not receive TXA, with similar hemoptysis severity level. The main purpose of this study was to determine if nebulized TXA led to less invasive procedures for the management of bleeding. Other factors evaluated were the time to bleeding resolution and the incidence of hemoptysis recurrence.

Results: Fifteen patients treated with TXA were compared to 65 patients who did not receive TXA. There was no difference in the number of patients who needed an invasive procedure between the TXA group (40%) compared to patients who did not get TXA (52.3%). Additionally, bleeding did not resolve any faster and there was no difference in the incidence of recurrent bleeding between the two groups.

Conclusions: Nebulized TXA may be considered for the treatment of hemoptysis. More studies with more patients are needed to truly determine the effects of nebulized TXA.

Scientific Abstract

Objective: The objective of this analysis was to evaluate the efficacy of nebulized TXA administration compared to conventional management in patients with severe hemoptysis.

Methods: This IRB-approved, single-center, retrospective matched cohort study was performed between January 2018 and March 2021. All patients who received at least one dose of nebulized TXA were matched with up to five controls based on available severity criteria. The primary outcome was the need for invasive interventions for the management of hemoptysis. Secondary outcomes included time to hemoptysis resolution, hemoptysis recurrence, and hospital length of stay.

Results: Fifteen patients treated with nebulized TXA were identified and matched with 65 controls. There was no difference in the number of patients who required an invasive intervention between the TXA (40%) vs control group (52.3%), P=0.390. Additionally, no difference was found in the time to hemoptysis resolution (P=0.061), hemoptysis recurrence (P=1.000), or hospital length of stay (P=0.071).

Conclusions: In patients with hemoptysis, nebulized TXA may be considered as a non-invasive option for the management of hemoptysis. A larger analysis is warranted to determine the impact of nebulized TXA on invasive interventions for bleeding management.

Clinical Implications
Inhaled tranexamic acid used for the management of hemoptysis (coughing up blood from the respiratory tract) did not prevent more patients from needing invasive surgery. More studies with more patients may show a benefit to the inhaled tranexamic acid.

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