Tranexamic acid (TXA) is a synthetic anti-fibrinolytic agent used to treat many different bleeding complications. It’s implications in trauma as well as its various routes of administration including orally, IV, and topically have been well studied. However there are rather few studies that detail the benefit of nebulized TXA. One case in particular involving massive hemoptysis that was treated with nebulized TXA successfully was published in The Journal of Emergency Medicine in May 2018. In this case a 69 yr old F, DNR/DNI, with hx of stage IV lung adenocarcinoma and PE (on Xarelto) presented to the ED with massive hemoptysis and slowly decompensated during her stay. Given that intubation was not an option, an alternative treatment therapy was attempted. The pt was given nebulized TXA. Within 10 min of TXA administration, her hemoptysis resolved, her respiratory distress improved, and her vital signs stabilized. She was admitted to the ICU and had no subsequent episodes of hemoptysis and was discharged 5 days later.
There are approx 12 case reports that highlight the benefit of neublized TXA in massive hemoptysis. In each of these cases, TXA had a 100% success rate in halting hemoptysis and there were no serious adverse events. Now how do we do this? Easy….Just get 500mg of TXA mixed with 10cc of NS and give as a nebulizer. This can help avoid intubation, help those DNR/DNI pts who refuse getting the tube, and can help avoid reversal of anticoagulation in high risk pts (recent PE, CAD/stents) where the benefits of receiving that anticoagulation outweigh the risk of stopping or reversing it.
Bottom Line: In HDS patients with acute hemoptysis 500mg of TXA mixed with 10cc of NS given as a nebulizer can be a temporizing measure to halt bleeding
1.) Komura S et al. Hemoptysis? Try Inhaled Tranexamic Acid. J Emerg Med 2018. PMID: 29502864
2.) A. Gadre, J.K. StollerTranexamic acid for hemoptysis: a review. Clin Pulm Med, 24 (2017), pp. 69-74