In this episode, I’ll discuss the dose of inhaled tranexamic acid used for nonmassive hemoptysis.
Tranexamic acid (TA) is an antifibrinolytic medication. It forms a reversible complex that displaces plasminogen from fibrin resulting in inhibition of fibrinolysis. Tranexamic acid is commonly used systemically to reduce bleeding in trauma or topically or systemically to reduce bleeding in orthopedic surgical procedures.
There is one prospective study in adult patients of the effectiveness of inhaled tranexamic acid for the treatment of nonmassive hemoptysis.
The study was a double-blind, randomized controlled trial of treatment with nebulized tranexamic acid vs normal saline placebo in patients admitted with hemoptysis.
Patients in the active group got undiluted inhalations of IV form of tranexamic acid 500 mg/5 ml 3-4 times a day.
Mean hospital length of stay was 2 days shorter for the tranexamic acid group (5.7 ± 2.5 days vs 7.8 ± 4.6 days; P = .046). Fewer patients in the tranexamic acid group required invasive procedures such as interventional bronchoscopy or angiographic embolization to control the bleeding (0% vs 18.2%; P = .041). There were no side effects noted in either group throughout the follow-up period. A reduced hemoptysis recurrence rate was noted at the 1-year follow-up (P = .009 in the tranexamic acid group).
If using this off-label strategy, give preference to the preservative-free version of IV tranexamic acid due to the potential adverse effects of nebulized preservatives.
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