Nebulized vs IV Tranexamic Acid for Hemoptysis: A Pilot Randomized Controlled Trial

Area of Science:

• Pulmonary Medicine
• Emergency Medicine
• Pharmacology

Background:

• Tranexamic acid (TA) is a hemostatic agent used for bleeding control.
• Limited research exists on the comparative efficacy of different TA administration routes for hemoptysis.

Purpose of the Study:

• To compare the efficacy of nebulized TA versus intravenous (IV) TA in reducing hemoptysis in emergency department (ED) patients.
• To evaluate secondary outcomes including bleeding amount, procedural interventions, and side effects.

Main Methods:

• A pragmatic, open-label, randomized pilot trial involving adult patients with active hemoptysis.
• Participants received either nebulized TA (500 mg tid) or IV TA (500 mg tid).
• Primary outcome was bleeding cessation at 30 minutes; secondary outcomes included bleeding amount, interventions, and side effects.

Main Results:

• Nebulized TA demonstrated significantly higher rates of bleeding cessation at 30 minutes compared to IV TA (P = .0019).
• Reduced hemoptysis was observed in the nebulized group at all time points (P < .05).
• Fewer patients receiving nebulized TA required bronchial artery embolization (P = .024), leading to higher ED discharge rates (P = .005).

Conclusions:

• Nebulized tranexamic acid appears more effective than IV TA for managing mild hemoptysis, reducing bleeding and the need for interventions.
• Larger studies are warranted to confirm these findings and explore nebulized TA's full potential.