Combined therapy with bronchial artery embolization and tranexamic acid for hemoptysis

Abstract

Background While most previous studies have viewed tranexamic acid as a bridging or temporary therapy, our preliminary study offers insights into the combined therapy of antifibrinolytic agent with endovascular treatment for hemoptysis. Purpose To investigate the feasibility and safety of combined therapy, to analyze factors affecting the outcomes of combined therapy, and to compare the effectiveness of combined therapy between groups with different etiologies. Material and Methods Between January 2011 and December 2014, 64 patients (33 men, mean age 64.6 years) underwent combined therapy for hemoptysis. The median follow-up time was 14.7 months (range 174–2435 days). Patients were divided into a tuberculosis group (GroupTB, n=37) and a non-tuberculosis group (Groupnon-TB, n=27). Results Embolotherapy was technically successful in 62/64 (96.9%) cases. The immediate clinical success rate was 96.8% (60/62). The short-term and long-term recurrence rates were 12.9% (n=8) and 19.4% (n=12), respectively. The one-, two-, and four-year recurrence-free survival rates were 61%, 49%, and 32%, respectively. There was no significant survival difference between the two groups. Suboptimal embolization was a significant risk factor for immediate clinical failure (odds ratio 29.624, P = 0.023). Optimal embolization (hazard ratio [HR] 0.199, P = 0.023) and older age (HR 0.956, P = 0.013) were significantly associated with lower recurrence risk. Conclusion Combined therapy is an effective and safe treatment modality for hemoptysis of various etiologies, with potential benefits for short-term recurrence vis-a-vis current literature evidence. Suboptimal embolization was the most important modifiable risk factor for treatment failure and recurrence after combined therapy.

Analysis on the Efficacy of Bronchial Artery Chemoembolization Combined with 125I Seed Implantation in the Therapy of Advanced Non-Small-Cell Lung Cancer Based on the Medical Database

“…BACE is an emerging method of local interventional therapy in recent years, in which chemotherapy drugs are directly infused into the supplying vessels of the lesions through catheters, and BACE is able to rise drug concentrations entering the lesions compared with superficial intravenous chemotherapy [10]. It has been reported that local therapeutic efficacy of BACE is 2-6 times that of intravenous chemotherapy [11]. BACE can maximize the therapeutic effect with a relatively small amount of chemotherapeutic drugs [12].…”

Recurrent Hemoptysis Post Re-Embolization in a 49 Year-Old Male with Post Tuberculosis Lung Disease (PTLD) and Bronchiectasis

“…Recurrent bleeding after embolization has been reported in 10-55% of cases. This can occur due to imperfect embolization, recanalization of embolized blood vessels, collateral circulation, or the progression of the underlying disease 16 .…”

Haemoptysis in Pulmonary Arterial Hypertension Associated with Congenital Heart Disease: Insights on Pathophysiology, Diagnosis and Management

“…Regarding its effectiveness in haemoptysis, it has been studied only in few trials. Typically, TA is administered orally [62] or intravenously [63], yet inhaled [64,65] and endobronchial [66] forms have been recently discussed.…”

“…Bronchial artery embolization (BAE) is a minimally invasive and efficient technique in managing massive and recurrent haemoptysis as a single therapy or in combination with conservative medication or surgery [13,62]. BAE, first introduced by Remy et al in 1974 [76], is performed in view of lowering the perfusion pressure by occluding the systemic arterial inflow of the culprit vessels [25].…”

“…Generally, deficient embolization of the culprit vessels is responsible for early re-bleeding, whereas late-term recurrence may result from recanalization or further hypervascularization leading to the formation of new collaterals [13,81]. Combined therapy with BAE and TA may assist in achieving lower relapsing rates following BAE [62].…”