Pulmonary hemorrhage: A novel mode of therapy

Major hemoptysis a potentially life-threatening condition in pulmonology and can originate from both identifiable and unidentifiable sites. Identifiable bleeding sites can be controlled locally by iced saline, vasopressors, laser, electrocautery and balloon tamponade. Bleeding from an unidentifiable source, on the other hand, is much more difficult to control as the bleeding site is not accessible by the bronchoscope. Tranexamic acid (TA), a synthetic anti-fibrinolytic agent, is approved for treatment or prophylaxis of bleeding episodes in hemophilia or following major operative procedures via intravenous or oral routes. Its efficacy in controlling bleeding from mucosal tissue led us to apply it to patients with pulmonary bleeding. Six patients with significant hemoptysis, two who bled during bronchoscopy biopsy and four with spontaneous bleeding (lung cancer, diffuse alveolar hemorrhage, idiopathic pulmonary bleeding, metastatic thyroid carcinoma) were treated with TA. For the two who bled during bronchoscopy, we used a bolus of 500mg/5mL through the bronchoscope working channel, while the latter four received aerosolized TA 500mg/5ml 3-4 times a day. In all cases, the bleeding stopped with the first dose of TA, and the treatment was well tolerated without adverse events. While limited due to the small number of patients, these data show that TA administered either as a bolus through the bronchoscope or via inhalation seems to be effective in controlling severe hemoptysis from both identifiable and unidentifiable bleeding sites. Further clinical studies are needed to evaluate the use of the TA in this set-up.