- Tranexemic acid (TXA) is a synthetic lysine analog that inhibits fibrinolysis by competitively binding sites of plasminogen and plasmin, thereby preventing the activation of plasminogen and its conversion to plasmin, reducing fibrin degradation and exerting a hemostatic effect.
- Systemic administration of TXA has been proven effective in treating pulmonary hemorrhage. Kinoshita et al (Critical care.2019) did a retrospective study to asses the effect of TXA (n=17049) on in hospital mortality among patients with hemoptysis against a control group (n=11490). Study found that patients treated with tranexemic acid has significantly lower in-hospital mortality (11.5% vs. 9.0%; risk difference, − 2.5%; 95% confidence interval (CI), − 3.5 to − 1.6%), shorter hospital stays (18 ± 24 days vs. 16 ± 18 days; risk difference, − 2.4 days; 95% CI,− 3.1 to − 1.8 days).
- Recently few studies have shown nebulised therapy promising results. Nebulised therapy directly targets the respiratory tract and lungs, thereby reducing the local drug concentration, low dose, convenient application and few side effects. Nebulised therapy acts locally thereby reducing risk of thrombosis.
Evidence
- Wand et al (CHEST.2018) did a prospective RCT to assess the efficacy and safety of nebulized tranexemic acid in treating hemoptysis. The study compared nebulized TXA with placebo in patients with hemoptysis from various causes, excluding those with massive hemoptysis. The regimen involved nebulizing TXA at 500 mg/5 ml or 0.9% saline at 5 ml, three times a day. A total of 47 patients were included (25 in the TXA group and 22 in the placebo group). Results showed that, compared with those the placebo group, patients in the nebulized TXA group had a significant reduction in hemoptysis volume from the second day of admission, with a higher rate of hemoptysis resolution within 5 days of admission (96% vs 50%; P < 0.0005).
- Gopinath et al (CHEST. 2023) did a pragmatic, open-label, randomized, parallel, single-center, pilot trial of nebulized TA (500 mg tid) vs IV TA (500 mg tid) in adult patients presenting to the ED with active hemoptysis.The results revealed that the 30-min hemoptysis cessation rate in the nebulized TXA group (72.72%) was significantly higher than that in the intravenous TXA group (50.91%). Additionally, the amount of hemoptysis in the nebulized group was significantly reduced at all observed time points. With respect to safety, no significant adverse reactions occurred in either group.
Reference
- Zhang, P., Zheng, J., Shan, X. et al. Advances in the study of nebulized tranexamic acid for pulmonary hemorrhage. Eur J Clin Pharmacol 81, 237–246 (2025). https://doi.org/10.1007/s00228-024-03784-5
- Kinoshita, T., Ohbe, H., Matsui, H. et al. Effect of tranexamic acid on mortality in patients with haemoptysis: a nationwide study. Crit Care 23, 347 (2019). https://doi.org/10.1186/s13054-019-2620-5
- Gopinath B, Mishra PR, Aggarwal P, Nayaka R, Naik SR, Kappagantu V, Shrimal P, Ramaswami A, Bhoi S, Jamshed N, Sinha TP, Ekka M, Kumar A. Nebulized vs IV Tranexamic Acid for Hemoptysis: A Pilot Randomized Controlled Trial. Chest. 2023 May;163(5):1176-1184. doi: 10.1016/j.chest.2022.11.021. Epub 2022 Nov 19. PMID: 36410494.
