Treatment of Recurrent Severe Hemoptysis in Cystic Fibrosis with Tranexamic Acid

Abstract

Major hemoptysis is a potentially life-threatening complication of cystic fibrosis (CF) lung disease. Bronchial artery embolization (BAE) along with treatment of a CF pulmonary exacerbation has become the most widely used therapeutic approach for major hemoptysis in CF. However, BAE has been associated with severe complications, especially when bronchial artery to spinal artery anastomoses are present. This case study describes the successful treatment of major hemoptysis in CF with tranexamic acid, in an individual in whom 12 previous BAE procedures had been performed and further procedures were contraindicated secondary to bronchial artery to spinal artery collaterals. Recurrence of the hemoptysis occurred after attempts had been made to withdraw the tranexamic acid. Tranexamic acid was resumed with resolution of the hemoptysis, and the therapy has been used continuously for 13 months without any complications.

Massive Hemoptysis: An Update on the Role of Bronchoscopy in Diagnosis and Management

“…TA was eventually started and controlled bleeding effectively for 5 months, until a recurrent episode prompted surgical resection. Graff [77] reported another successful trial of oral TA treatment in a cystic fibrosis patient after 12 previous BAE procedures had failed to control relapse of hemoptysis. Further BAE was counter-indicated because of bronchial to spinal artery collaterals.…”

Treatment massive haemoptysis in cystic fibrosis with tranexamic acid

“…The evidence base supporting the use of tranexamic acid for treating haemoptysis in patients with CF is limited to single case reports. 6,7 Tranexamic acid is a lysine derivative that blocks the lysine binding sites on plasminogen, preventing the plasmin-tPA complex from binding to fibrin, thus inhibiting fibrinolysis. 8 Administration by IV and oral routes result in peak serum levels after one and three hours, respectively.…”

Management of pediatric hemoptysis: Review and a case of isolated unilateral pulmonary artery agenesis

“…Pharmacologic therapies have been described, including intravenous vasopressin for bronchial artery constriction and oral tranexamic acid for clot stabilization [7,14,15]. Bronchoscopic intervention may be required for active bleeding.…”