Nebulized tranexamic acid may better address hemoptysis than IV administration
Key takeaways:
- More patients in the ED with hemoptysis saw an end to the condition with nebulized vs. IV tranexamic acid.
- Discharge rates were greater among patients who received nebulized tranexamic acid.
Compared with IV tranexamic acid, nebulized tranexamic acid resulted in more instances of hemoptysis cessation and lower amounts of bleeding as time passed from administration, according to results published in CHEST.
“Nebulized tranexamic acid may be more efficacious than IV tranexamic acid in reducing the amount of hemoptysis and need for ED interventional procedures,” Bharath Gopinath, MBBS, MD, junior resident of emergency medicine at All India Institute of Medical Sciences, and colleagues wrote.
In a pilot, open-label, single-center, randomized, controlled trial, Gopinath and colleagues assessed 110 adults (mean age, 42.92 years; 70% men) in an ED in India with hemoptysis treated three times a day with either 500 mg of nebulized tranexamic acid (n = 55) or 500 mg of IV tranexamic acid (n = 55) to see which method leads to a higher rate of hemoptysis cessation 30 minutes after administration and lower hemoptysis amounts 6 hours, 12 hours and 24 hours after administration.
Researchers also evaluated interventional procedures and side effects of tranexamic acid in both groups.
Patients in the cohort had been experiencing hemoptysis for a median 3.5 days, and most cases were considered minor with a median of about 100 mL of hemoptysis in the 24 hours before ED admission, according to researchers.
Thirty minutes after receiving tranexamic acid, researchers found that bleeding stopped in 40 patients (72.72%) who received the nebulization mode of delivery, compared with only 28 patients (50.91%) who received the IV mode of delivery (P = .0019).
Similar to the above finding, patients receiving nebulized vs. IV tranexamic acid had lower median amounts of hemoptysis at 30 minutes (0 mL; IQR, 0-5 mL vs. 0 mL; IQR, 0-20 mL; P = .011), 6 hours (5 mL vs. 20 mL; P = .002), 12 hours (10 mL vs. 40 mL; P = .0008) and 24 hours (10 mL vs. 80 mL; P = .005) after delivery.
Fewer patients needed bronchial artery embolization among the nebulized treated group vs. the IV treated group (25.49% vs. 47.72%; P = .024), which contributed to this group’s greater ED discharge rate (67.92% vs. 39.02%; P = .005), according to researchers. Notably, researchers could not find any data on bronchial artery embolization for four patients who received nebulized tranexamic acid and 11 patients who received IV tranexamic acid.
No patients in either treatment group underwent a surgical procedure or experienced major adverse effects of tranexamic acid.
When evaluating side effects of the different modes of delivery, researchers observed asymptomatic bronchoconstriction in two patients who received nebulized tranexamic acid; however, this effect resolved following short-acting beta-agonist nebulization.
Of the cohort of discharged patients, none of them had an interventional procedure or went back to the ED 72 hours after their discharge with bleeding, according to researchers.
“The nebulized route may be preferred over the IV route due to its noninvasive nature, ease and rapidity of starting the treatment,” Gopinath and colleagues wrote. “Future larger studies are needed to further explore the potential of nebulized tranexamic acid compared to IV tranexamic acid in patients with hemoptysis.”
This study by Gopinath and colleagues presents evidence that the way tranexamic acid is administered changes outcomes for patients with hemoptysis and prompts several ideas for future investigations, according to an accompanying editorial by Jiwoon Chang, MD, clinical assistant professor in the division of pulmonary, allergy and critical care medicine at Stanford University School of Medicine, and Kevin C. Ma, MD, assistant professor of clinical medicine at Perelman School of Medicine at the University of Pennsylvania.
“Future research should focus on evaluating tranexamic acid in more diverse settings, integrating tranexamic acid in massive hemoptysis management, adding saline placebos for nebulized and IV tranexamic acid, and following up for a longer period for potential side effects of tranexamic acid and hemoptysis recurrence,” Change and Ma wrote.