Placebo-controlled RCT: In hemoptysis, inhaled tranexamic acid increased resolution rate at 5 d and reduced expectorated blood volume from 2 d.
Wand O, Guber E, Guber A, et al. Inhaled Tranexamic Acid for Hemoptysis Treatment: A Randomized Controlled Trial. Chest. 2018 Dec;154(6):1379-1384. doi: 10.1016/j.chest.2018.09.026. Epub 2018 Oct 12.

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.

Ratings
Specialty Area Score
Hemostasis and Thrombosis
Respirology/Pulmonology
Hospital Doctor/Hospitalists
Internal Medicine
Comments from MORE raters

Hemostasis and Thrombosis

The study has some limitations (mainly the small sample size). There are interesting data. It could certainly help for difficult situations.

Small randomized placebo-controlled trial with impressive results. Inhaled TA not only decreased hemoptysis duration and amount, but also was associated with fewer procedures and decreased LOS.

This work nicely shows that TA inhalations can be used safely and effectively to control bleeding in patients with non-massive hemoptysis. This trial is important for chest physicians.

Excellent trial with useful results.

Hospital Doctor/Hospitalists

The study is limited by its small size, but interesting idea and results.

This is a clear example of a potentially relevant intervention that had not been tested formally in a trial until now... perhaps because of the low cost of tranexamic acid (?). EBM needs more relevant trials not driven by very expensive drugs!

Respirology/Pulmonology

Interesting study, although the small number of participants merits further trials. Unfortunately, in developing countries, the main etiology of hemoptysis is tuberculosis (current or sequelae of TB) and this study did not include any cases of TB.

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