Pulmonary hemorrhaging, or hemoptysis, can vary in severity depending on location and underlying etiology.
Pulmonary hemorrhaging, or hemoptysis, can vary in severity depending on location and underlying etiology. In the setting of massive or worsening hemoptysis, uncontrolled bleeding can obstruct the airway leading to inadequate gas exchange and hemodynamic instability.
Tranexamic acid is a commonly used hemostatic agent. More known for intravenous and oral administration, other routes of administration have been investigated. Oral won't be preferred in acute cases with blood in the airway. Intravenous TXA systemically controls bleeding, but nebulozed may be preferred for localized effect.
The use of nebulized tranexamic acid has been investigated as a potential route of administration for non-massive hemoptysis. Literature is limited to case reports and one small randomized trial, which associate TXA with a quicker time to hemorrhage control compared to placebo, shorter hospital length of stays, and less interventional procedures required to control bleeding.
The single, small RCT by and colleagues nebulized 500 mg every 8 ho\
urs. Keep in mind that the TXA vial comes as a 1000 mg/10 mL (10mg/mL) and was only studied in non-massive hemoptysis. Monitor for bronchospasm and thrombus formation.
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References
Davidson K, Shojaee S. Managing massive hemoptysis. Chest. 2020;157(1):77-88.
Wand O, Guber E, Guber A, Epstein Shochet G, Israeli-Shani L, Shitrit D. Inhaled tranexamic acid for hemoptysis treatment: a randomized controlled trial. Chest. 2018;154(6):1379-1384.
Alabdrabalnabi F, Alshahrani M, and Ismail N. Nebulized tranexamic acid for recurring hemoptysis in critically ill patients: case series. Int J Emerg Med. 2020 Aug 20;13(1):45.doi: 10.1186/s12245-020-00304-x.
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