Combined Nebulized and IV Tranexamic Acid for Hemoptysis Management: A Case Report and Brief Literature Review

Hemoptysis management may necessitate invasive interventions, but combined nebulized and intravenous tranexamic acid (TXA) can play a promising noninvasive role in controlling hemoptysis. This case report describes two patients with non-life-threatening hemoptysis (a 71- and a 69-year-old man) successfully treated with combined nebulized and systemic IV TXA. A 71-year-old man with COPD exacerbation and non-life-threatening hemoptysis was successfully treated with TXA (both IV and nebulized) and standard care, which controlled the bleeding without adverse events or recurrence, and was discharged after 7 days. A 69-year-old male with bronchiectasis exacerbation experienced non-life-threatening hemoptysis. He was successfully treated with IV and nebulized TXA along with standard care, resolving the hemoptysis without recurrence and discharging the patient 8 days after admission. Existing evidence supports nebulized TXA's localized action, minimizing systemic absorption and thrombotic risks, though its efficacy on hemoptysis remains unproven. A brief review of 30 cases highlights nebulized TXA's high success rate with doses ranging from 250 to 2000 mg, though rare side effects like bronchospasm and serotonin-like syndrome warrant caution. Playing a role as a potential alternative approach for antifibrinolytic administration in hemoptysis, especially for high-thrombotic-risk patients, and serving as a vital stabilization and bridging strategy before definitive interventional procedures, could be the main area for future studies.