In this episode, I’ll discuss the IV vs nebulized route for tranexamic acid to treat hemoptysis.
In the treatment of hemoptysis, tranexamic acid has been given via the IV route and topically via nebulization. These two routes of administration were compared in a randomized controlled trial for the first time recently and the results were published in the journal Chest.
This was an open label randomized trial of 110 patients who were evenly split between IV and nebulized tranexamic acid groups. The IV group received tranexamic acid 500 mg IV 3 times daily and the nebulized group received tranexamic acid 500 mg via nebulizer 3 times daily.
All patients presented via the ED and have active hemoptysis but were hemodynamically stable. The primary outcome was cessation of bleeding at 30 minutes.
73% of the patients in the nebulized group vs 51% of patients in the IV group achieved cessation of bleeding within 30 minutes. This difference was statistically significant.
The nebulized group was also favored in secondary outcomes including the volume of hemoptysis at 6, 12, and 24 hours and the need for bronchial artery embolization. All of these differences were also statistically significant.
There were 2 patients who received nebulized tranexamic acid that experienced asymptomatic bronchoconstriction however, this resolved after albuterol was given.
The authors concluded:
Nebulized TA may be more efficacious than intravenous TA in reducing the amount of hemoptysis and need for ED interventional procedures. Future larger studies are needed to further explore the potential of nebulized TA compared to intravenous TA in patients with mild hemoptysis
While larger studies are always welcome, for many clinicians this study will be enough to prefer nebulized tranexamic acid over IV, at least for patients with hemodynamically stable hemoptysis.
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