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

Abstract

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.

Inhaled Tranexamic Acid for the Management of Hemoptysis in a Patient With Right and Left Ventricular Assist Devices: A Case Report

“…Additional case reports have also supported the use of inhaled TXA to treat pulmonary hemorrhage. 3,10,11 Bleeding complications are common in patients with MCS devices affecting 33% to 52% of patients. 8 More specifically, in the setting of an RVAD, there may be an increase in pulmonary hemorrhage due to flow and device characteristics, as well as the anatomic location of the device outflow cannula.…”

“…Intravenous TXA is the most widely studied, with demonstrated efficacy in surgical, obstetric, and trauma populations. 3 TXA has also been shown to be effective in treating surgical and nonsurgical bleeding in patients with Von Willebrand disease. 4 Systemic antifibrinolytics are associated with thrombus formation, especially in patients in a prothrombotic state.…”

“…Additional case reports have also supported the use of inhaled TXA to treat pulmonary hemorrhage. 3,10,11…”

Treatment of Massive Hemoptysis with Repeated Doses of Nebulized Tranexamic Acid

“…Case reports have described the successful use of nebulized TXA in massive and submassive hemoptysis and pulmonary haemorrhage [6][7][8]. However, case reports and case series in the emergency medicine literature describe a single treatment of nebulized TXA.…”

Tranexamic acid‐associated fatal status epilepticus in a paediatric non‐cardiac surgery: A case report and literature review

“…TXA can be administered via many routes, including oral and IV bolus and infusion routes (FDA and WHO approved), topical for epistaxis, 5 inhalation for pulmonary haemorrhage 6 and nebulized for haemoptysis 7 …”