Nebulized versus intravenous tranexamic acid for hemoptysis: A pilot randomized controlled trial

Senior Resident, Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi 110029. Electronic address: Bharathg531@gmail.com. Assistant Professor, Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi 110029. Electronic address: ranjan.prakashmishra@gmail.com. Professor & Head, Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi 110029. Electronic address: peekay_124@outlook.in. Senior Resident, Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi 110029. Electronic address: rakeshnayaka100@gmail.com. Senior Resident- Infectious diseases, Department of Medicine, All India Institute of Medical Sciences, New Delhi 110029. Electronic address: drshivdasaiims.jul16@aiims.edu. Senior Resident, Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi 110029. Electronic address: vignan_1504@yahoo.in. Senior Resident, Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi 110029. Electronic address: Prawalaiimspulse@gmail.com. Senior Resident, Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi 110029. Electronic address: 1312ashura@gmail.com. Professor, Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi 110029. Electronic address: sanjeevbhoi@gmail.com. Additional Professor, Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi 110029. Electronic address: jamshednayer@gmail.com. Associate Professor, Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi 110029. Electronic address: drsinha123@gmail.com. Associate Professor, Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi 110029. Electronic address: drmeera_2004@yahoo.co.in. Associate Professor, Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi 110029. Electronic address: akshay2111@gmail.com.

Chest. 2022

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PICO Summary

Population

Adult patients presenting to emergency department with active hemoptysis (n= 110).

Intervention

Nebulized tranexamic acid (TA), (n= 55).

Comparison

Intravenous TA (n= 55).

Outcome

Hemoptysis cessation at 30 minutes after TA administration was significantly higher in the nebulized arm (n= 40) compared with the intravenous arm (n= 28), (X2 (1, n= 110) = 5.55). Hemoptysis amount reduced significantly in the nebulization arm at all time periods of observation (30 minutes, 6, 12 and 24 hours). Fewer patients in the nebulized arm required bronchial artery embolization (13 vs. 21) and thereby higher discharge rates from the emergency department (ED), (67.92% vs. 39.02%). Two patients in the nebulized arm had asymptomatic bronchoconstriction which resolved after short acting beta agonist nebulization. No patient discharged from ED underwent any interventional procedure or revisited the ED with rebleed during the 72 hours follow up period.
Abstract
BACKGROUND Tranexamic acid (TA) is used to control bleeding in patients with hemoptysis. However, the effectiveness of the different routes of TA administration has not been studied. RESEARCH QUESTION Does nebulized route of Tranexamic Acid (TA) administration reduce the amount of hemoptysis compared to intravenous route in patients presenting to emergency department (ED) with hemoptysis? METHODS We conducted a pragmatic, open labelled, cluster randomized, parallel single centered pilot trial of nebulized TA (500mg tid) versus intravenous TA (500mg tid) in adult patients presenting to emergency department with active hemoptysis. The primary outcome was cessation of bleeding at 30 min. Secondary outcome included amount of hemoptysis at 6h, 12h and 24 h; interventional procedures and side effects of TA. Patients who were hemodynamically unstable or requiring immediate interventional procedure or mechanical ventilation were excluded from the study. RESULTS Of the 55 patients in each arm, hemoptysis cessation at 30 minutes after TA administration was significantly higher in nebulized arm (n=40) compared to intravenous arm (n=28) [X2 (1, n=110)=5.55, p=0.0019]. Also, hemoptysis amount reduced significantly in nebulization arm at all time periods of observation (P value 30min=0.011, at 6h=0.002, 12h=0.0008, 24h=0.005). Fewer patients in nebulized arm required bronchial artery embolization (13 vs 21, P value=0.024) and thereby higher discharge rates from the ED (67.92% vs 39.02%, P value=0.005). Two patients in nebulized arm had asymptomatic bronchoconstriction which resolved after short acting beta agonist nebulization. No patient discharged from ED underwent any interventional procedure or revisited the ED with rebleed during the 72 hours follow up period. INTERPRETATION Nebulized TA may be more efficacious than intravenous TA in reducing the amount of hemoptysis and need for ED interventional procedures. Future larger studies are needed to further explore the potential of nebulized TA compared to intravenous TA in patients with mild hemoptysis.
Study details
Language : eng
Credits : Bibliographic data from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine