The Data

- Case series and case reports; no RCTs to date

- Pooling published data together, a total of nine patients received nebulized tranexamic acid for treatment of their hemoptysis

- In one series, TXA was used when the source could not be found during bronchoscopy and bleeding continued despite standard treatment. All of the patients bleeding resolved with the first TXA treatment (2)

- Another series continued the treatments every 6 hours both to treat and prevent rebleeding (1)

Side Effects

One patient developed bronchospasm which was successfully treated with bronchodilators.

No patients had systemic side effects or thromboembolic events

How to Perform

- 500mg of tranexamic acid IV formulation

- Placed in a traditional nebulizer

- Administered over 15 minutes

In Conclusion

- Practical and inexpensive

- Strength in it’s utility as a temporizing measure for patients who will require bronchoscopy

- Caution should be maintained in clinically stable patients or those with mild hemoptysis as there is insufficient data regarding side effects

- Would not recommend treating a mild case with nebulized TXA and discharging

Check out a recent discussion on the use of Nebulized TXA between EM Daily Editor Chad Simpkins and Emergency Medicine News podcasters Richard Pescatore and Martha Roberts: EMN Live: The Swiss Army Knife of Bleeding: TXA http://journals.lww.com/em-news/Pages/podcastepisodes.aspx?podcastid=7

The articles reviewed for the use of nebulized tranexamic acid include:

1. Segrelles Calv G, et al. Inhaled tranexamic acid as an alternative for hemoptysis treatment. Chest. 2016;149;604.

2. Solomonov A, et al. Pulmonary hemorrhage: a novel mode of therapy. Respir Med. 2009;103;1196-1200. 3. Hankerson MJ, et al. Nebulized tranexamic acid as a noninvasive therapy for cancer-related hemoptysis. J Palliat Med. 2015;18;1060-1062.