First10EM - May 26, 2019 - By Justin Morgenstern
"Hemoptysis can be scary. I covered the emergency medicine approach to massive hemoptysis in one of the early posts on First10EM. However, even when the hemoptysis is small volume, it can be quite distressing to patients and clinicians alike. This paper asks whether using nebulized tranexamic acid (or TXA) for hemoptysis results in less bleeding.
The paper: Wand O, Guber E, Guber A, Epstein Shochet G, Israeli-Shani L, Shitrit D. Inhaled Tranexamic Acid TXA for Hemoptysis Treatment: A Randomized Controlled Trial. Chest. 2018; 154(6):1379-1384. PMID: 30321510
Bottom line:
This is a small trial with lots of issues, but it hints that in stable inpatients with small volume hemoptysis, the use of nebulized TXA might reduce bleeding. The trial is too small to comment on harms. We need to see this trial replicated, preferable in a larger multicentre RCT, before this becomes standard care, but I think it would be reasonable to use this therapy while waiting for more trials to be completed."