Mary Kovacevic, BCCCP, BCPS, PharmD
Clinical Pharmacy Specialist
Brigham & Women's Hospital
Boston, Massachusetts
Disclosure information not submitted.
Kevin Dube, BCCCP, BCPS, PharmD
Clinical Pharmacy Specialist
Brigham & Women's Hospital
Boston, Massachusetts
Disclosure information not submitted.
.jpg "Afrah Alkazemi, MS, PharmD, BCPS photo")
Afrah Alkazemi, MS, PharmD, BCPS
Assistant Professor
Kuwait University, Faculty of Pharmacy
Boston, Massachusetts, United States
Disclosure information not submitted.
Julie Lauffenburger, PharmD, PhD
Assistant Professor of Medicine
Brigham and Women’s Hospital, Harvard Medical School, United States
Disclosure information not submitted.
Adam Smith, RRT-ACCS
ECMO Coordinator and Clinical Educator
Brigham and Women's Hospital, United States
Disclosure information not submitted.
Stephen Malinowski, RRT
Registered Respiratory Therapist
Brigham and Women's Hospital, United States
Disclosure information not submitted.
Gerald Weinhouse, MD
Brigham & Women's Hospital
Boston, Massachusetts
Disclosure information not submitted.
Title: Efficacy of Nebulized Tranexamic Acid for Severe Hemoptysis at a Tertiary Academic Medical Center
Introduction: The management of hemoptysis mainly consists of invasive interventional procedures, consisting of angiographic bronchial artery embolization and various endobronchial interventions. However, there are limited effective non-invasive medical therapies available. A small randomized controlled trial and case reports suggest that nebulized tranexamic acid (TXA) may lead to a faster time to hemoptysis resolution and decreased need for invasive interventions compared to placebo. The objective of this analysis was to evaluate the effectiveness and safety of nebulized TXA administration compared to conventional management in patients with hemoptysis.
Methods: This IRB-approved, single-center, retrospective matched cohort study was performed using data spanning from January 1, 2018 to March 31, 2021. Electronic health record data was used to identify all adult inpatients with hemoptysis (ICD-10 code R04.2). All patients who received ≥1 dose of nebulized TXA were matched with up to five controls based on available severity criteria (hemoptysis severity, need for mechanical ventilation, and SOFA score at the time of hemoptysis diagnosis) with coarsened exact matching. The primary outcome was the need for invasive interventions for the management of hemoptysis. Secondary outcomes included time to hemoptysis resolution, duration of mechanical ventilation, hemoptysis recurrence, and hospital length of stay.
Results: During the study period, a total of 15 patients treated with nebulized TXA were identified and matched with 65 controls. Patients were mostly male, had a mean age of 60 ± 16.3 years, with airway disease (35%) being the major etiology of hemoptysis. There was no difference in the number of patients who required an invasive intervention between the TXA (40%) vs control group (52.3%), P=0.390. Additionally, no difference was found in the time to hemoptysis resolution (P=0.061), duration on mechanical ventilation (P=0.111), hemoptysis recurrence (P=1.000), or hospital length of stay (P=0.071) in the TXA vs control group, respectively.
Conclusions: In patients with hemoptysis, nebulized TXA may be considered as a non-invasive option for the management of hemoptysis. A larger analysis is warranted to determine the impact of inhaled TXA on invasive interventions for bleeding management.