Tranexamic acid similar to adrenaline in stopping bleeding during bronchoscopy
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Key takeaways:
- Adrenaline and tranexamic acid each halted bleeding in 83.1% of patients.
- Moderate bleeding was stopped more than severe bleeding in both groups.
In flexible bronchoscopy, tranexamic acid appeared comparable to the standard topical hemostatic agent of adrenaline in stopping iatrogenic bleeding, according to results published in CHEST.
“We found no significant differences between adrenaline and tranexamic acid for controlling noncatastrophic iatrogenic endobronchial bleeding after cold saline failure,” Sonja Badovinac, MD, PhD, internal medicine specialist and respiratory medicine subspecialist at the clinic for lung diseases, Jordanovac, University Hospital Centre Zagreb, Croatia, and colleagues wrote.
In a double-blind, single-center, randomized controlled trial, Badovinac and colleagues analyzed 130 patients (median age, 67 years; 63.8% women) who underwent flexible bronchoscopy to determine whether tranexamic acid is similar to adrenaline — a frequent topical hemostatic agent used during this procedure — in terms of controlling iatrogenic bleeding.
Three applications of cold saline (5 mL) were given to every patient, and if bleeding continued, researchers randomly assigned them to either tranexamic acid (100 mg per application, 2 mL; n = 65) or adrenaline (0.2 mg per application, 2 mL; n = 65). Researchers found comparable demographics and procedure characteristics at baseline between both groups.
The maximum number of applications both groups of patients could receive was three; however, researchers permitted crossover when a patient did not stop bleeding.
Of the total cohort, over half of the patients (59.2%) experienced bleeding following endobronchial biopsy, and researchers observed controlled bleeding in the same number of patients receiving tranexamic acid and patients receiving adrenaline (54 patients each; 83.1%).
Crossover occurred in three patients initially receiving adrenaline and six patients initially receiving tranexamic acid.
To capture and compare patients’ bleeding severity level, a bronchoscopist employed a VAS, in which a score of 1 represented very mild bleeding and a score of 10 represented severe bleeding.
Both groups of patients had comparable bleeding severity scores, with a mean score of 4.9 in the adrenaline group and a mean score of 5.3 in the tranexamic acid group. Further, it took an average of 1.8 ± 0.8 applications to stop bleeding in both groups.
When evaluating success rates in stopping different levels of bleeding, researchers found high percentages of success in cases of moderate bleeding vs. severe bleeding for both adrenaline (86.7% vs. 40%; P = .008) and tranexamic acid (88.7% vs. 58.3%; P = .012), with similar rates between treatment groups. Patients with moderate bleeding also needed significantly fewer applications of both treatments.
In both groups, no drug-related adverse events occurred, according to researchers. However, it should be noted that three patients who received adrenaline and two patients who received tranexamic acid experienced a serious adverse event.
“Although limited by a select patient population and underrepresentation of some sampling methods, our results add to the body of evidence that topical tranexamic acid can be used safely and effectively during flexible bronchoscopy, providing an important additional therapeutic option, especially for situations when adrenaline raises safety concerns,” Badovinac and colleagues wrote.
With the findings from this study by Badovinac and colleagues, more steps are being taken to find the “most effective treatment” for bleeding that takes place during bronchoscopies, according to an accompanying editorial by Alberto E. Revelo, MD, and Nicholas J. Pastis, MD, FCCP, of the division of pulmonary, critical care & sleep medicine at The Ohio State University Wexner Medical Center.
“... Thanks to the authors, we are making progress toward the best modalities to treat this potentially life-threatening problem,” Revelo and Pastis wrote. “Yet, questions remain as to the agent of choice and how to modify that choice based on the cause of bleeding. Additional studies should be considered because it would be a tremendous victory for bronchoscopists if death caused by bronchoscopic bleeding (even though very rare) could be eradicated completely.”