Nebulized Tranexamic Acid as a Noninvasive Therapy for Cancer-Related Hemoptysis

Hankerson, Matthew J; Raffetto, Brian; Mallon, William K.; Shoenberger, Jan

doi:10.1089/jpm.2015.0167

Cited by 34 publications

(21 citation statements)

References 16 publications

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“…Moreover, the use of 250-500 mg 2.5 of nebulized TXA every 8-12 h for 4 patients revealed good response within hours to 2 days; one of the patients experienced bronchospasms which were treated [9]. Also, it was used in a patient with stage 4 squamous cell carcinoma of the piriform sinus with airway invasion and the bleeding stopped after 15 min of administering 1000 mg of nebulized TXA [10]. However, a nebulized TXA 500 mg used every 8 h for 48 h in two elderly patients complaining of bronchiectasis and thrombocytopenia results with complete cessation of bleeding [11] which was the same dose we used for our patients and showed the same effectiveness.…”

Section: Discussionmentioning

confidence: 99%

Nebulized tranexamic acid for recurring hemoptysis in critically ill patients: case series

2020

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Background: Hemoptysis is a clinical condition encountered in the emergency department (ED) and must be managed and investigated urgently to maintain the patient's hemostasis. The management of hemoptysis depends on treating the underlying cause. Tranexamic acid (TXA) is an anti-fibrinolytic drug used to systemically control bleeding. There are a few studies available that investigate the use of nebulized tranexamic acid for hemoptysis with contradictory results. Our paper demonstrates three cases where patients presented with significant hemoptysis and had significant improvement in symptoms following the administration of nebulized tranexamic acid. The overall need for blood transfusion was reduced. Results: Three patients presented to the emergency room for evaluation of hemoptysis. All three patients had different underlying pathologies resulting in their hemoptysis and were monitored in the ICU. Initial conventional medical therapies including the correction of coagulopathy and discontinuing offending agents were utilized for treatment. After persistent symptoms, nebulized TXA at a dose of 500 mg three times a day was administered. The patients were all discharged from the hospital with improvement in their symptoms. Conclusion: Tranexamic acid may be considered in the treatment of hemoptysis regardless of the underlying cause. This may be utilized pending further workup and investigation into the underlying source of the bleeding.

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Section: Discussionmentioning

confidence: 99%

Nebulized tranexamic acid for recurring hemoptysis in critically ill patients: case series

2020

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“…Other observational reports of using nebulized tranexamic acid have been in malignancy patients. (8,15,16) Although these studies indicate benefits, the systemic side effects in the form of thrombosis have not been investigated. Intravenous tranexamic acid administration is reported to be associated with thrombotic complications, (17)(18)(19) hence its use in the nebulized form should be with caution until definitively excluded with rigorous investigation.…”

Section: Discussionmentioning

confidence: 99%

Nebulized Tranexamic Acid Therapy for Hemoptysis Associated with Submassive Pulmonary Embolism

Dhanani

Roberts

Reade

2020

Journal of Aerosol Medicine and Pulmonary Drug Delivery

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Hemoptysis and pulmonary embolism (PE) are life-threatening pulmonary emergencies that, when present together, create a therapeutic conundrum. We present an illustrative case of a 65-year-old man with unprovoked submassive PE and moderate hemoptysis due to pulmonary infarction. Hemoptysis precluded systemic anticoagulation. Failing a conservative management strategy, we administered nebulized tranexamic acid. After four doses of nebulized tranexamic acid 500 mg, 6 hours apart, hemoptysis had ceased. Systemic anticoagulation with intravenous heparin was then successfully commenced 12 hours after the last episode of hemoptysis. The patient was weaned off high-flow nasal oxygen therapy over the course of the next 5 days with no hemoptysis recurrence. Noting the absence of trial evidence, but good pharmacological rationale and our positive experience, we suggest tranexamic acid is a useful noninvasive treatment option for the management of such conditions. Consent for this publication was obtained from the patient.

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“…An additional case report of cancer-related, non-massive hemoptysis described using a dose of TXA 1000 mg nebulized over 45 minutes. 15 We describe a case of massive hemoptysis in the setting of anticoagulation with a DOAC successfully treated with nebulized TXA at a dose of 500 mg.…”

Section: Discussionmentioning

confidence: 99%

“…Several concentrations of TXA have been documented in the literature as successfully nebulized, ranging from 10mg/mL to 100mg/mL. 2,8,15 The combination of undiluted tranexamic acid 100 mg/mL and the Micro Mist nebulizer resulted in crystallization that slowed the nebulization process. However, crystallization resolved after the addition of 3 mL of 0.9% sodium chloride.…”

Section: Discussionmentioning

confidence: 99%

Inhaled Tranexamic Acid for Massive Hemoptysis in the Setting of Oral Anticoagulation: A Case Report

Dempsey

Jones

Bronner

et al. 2020

Clinical Practice and Cases in Emergency Medicine

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Introduction: We discuss a case of massive hemoptysis in the setting of a direct-acting oral anticoagulant (DOAC) successfully managed with nebulized tranexamic acid (TXA). Case Report: Per the American College of Cardiology and the American Society of Hematology, it is recommended that significant bleeding associated with a DOAC be treated with either 4-factor prothrombin complex concentrate or andexanet alfa. However, our patient was at high risk for thrombotic complications given a recent pulmonary embolism. Conclusion: We demonstrate that it is reasonable to trial nebulized TXA given its low cost, ease of administration, and safety profile. Additionally, this report discusses a unique dosing strategy and a previously unreported complication associated with nebulization of undiluted TXA.

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Nebulized Tranexamic Acid as a Noninvasive Therapy for Cancer-Related Hemoptysis

Abstract: Nebulized TXA seems to be a safe, effective, and noninvasive method for controlling, or at least temporizing, hemoptysis in select patients. Nebulized TXA may be useful as a palliative therapy for chronic hemoptysis and as a tool in the acute stabilization of hemoptysis.

Cited by 34 publications

References 16 publications

Nebulized tranexamic acid for recurring hemoptysis in critically ill patients: case series

Nebulized tranexamic acid for recurring hemoptysis in critically ill patients: case series

Nebulized Tranexamic Acid Therapy for Hemoptysis Associated with Submassive Pulmonary Embolism

Inhaled Tranexamic Acid for Massive Hemoptysis in the Setting of Oral Anticoagulation: A Case Report

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