Abstract:
BACKGROUND:Tranexamic acid (TA) is an antifibrinolytic drug currently used systemically to control bleeding. To date, there have been no prospective studies of the effectiveness of inhaled TA for the treatment of hemoptysis. OBJECTIVES:The goal of this study was to prospectively assess the effectiveness of TA inhalations (ie, nebulized TA) for hemoptysis treatment. METHODS:This analysis was a double-blind, randomized controlled trial of treatment with nebulized TA (500 mg tid) vs placebo (normal saline) in patients admitted with hemoptysis of various etiologies. Patients with massive hemoptysis (expectorated blood > 200 mL/24 h) and hemodynamic or respiratory instability were excluded. Mortality and hemoptysis recurrence rate were assessed at 30 days and following 1 year. RESULTS:Forty-seven patients were randomized to receive TA inhalations (n = 25) or normal saline (n = 22). TA was associated with a significantly reduced expectorated blood volume starting from day 2 of admission. Resolution of hemoptysis within 5 days of admission was observed in more TA-treated patients than in those receiving placebo (96% vs 50%; P < .0005). Mean hospital length of stay was shorter for the TA group (5.7 ± 2.5 days vs 7.8 ± 4.6 days; P = .046), with fewer patients requiring invasive procedures such as interventional bronchoscopy or angiographic embolization to control the bleeding (0% vs 18.2%; P = .041). No side effects were noted in either group throughout the follow-up period. In addition, a reduced recurrence rate was noted at the 1-year follow-up (P = .009). CONCLUSIONS:TA inhalations can be used safely and effectively to control bleeding in patients with nonmassive hemoptysis. TRIAL REGISTRY:ClinicalTrials.gov; No.: NCT01496196; URL: www.clinicaltrials.gov.
journal_name
Chestjournal_title
Chestauthors
Wand O,Guber E,Guber A,Epstein Shochet G,Israeli-Shani L,Shitrit Ddoi
10.1016/j.chest.2018.09.026subject
Has Abstractpub_date
2018-12-01 00:00:00pages
1379-1384issue
6eissn
0012-3692issn
1931-3543pii
S0012-3692(18)32572-8journal_volume
154pub_type
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