The Egyptian Journal of Bronchology (Jul 2017)

Bronchoscopic instillation of tranexamic acid to control bronchopulmonary bleeding

  • Emad El-Din A. Korraa,
  • Ashraf M. Madkour,
  • Iman H. Galal,
  • Ibrahim M. Ibrahim El-Saidy

DOI
https://doi.org/10.4103/ejb.ejb_27_17
Journal volume & issue
Vol. 11, no. 3
pp. 244 – 249

Abstract

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Abstract Background Tranexamic acid (TA), a potent antifibrinolytic agent, has the potency to stop bleeding in a variety of medical and surgical conditions. However, its role in controlling airway bleeding is not yet proven. This study aimed to evaluate the efficacy of endobronchial administration of TA in controlling bronchopulmonary bleeding. Materials and methods A prospective, comparative, observational study was carried out including 40 patients scheduled to undergo bronchoscopy. For management of hemoptysis or bronchoscopy-induced bleeding, patients were randomly subdivided into two groups of 20 patients each: the first group received endobronchial TA, whereas the second group received endobronchial cold saline±adrenaline. Results In the TA group, 19 patients were responders and only one patient was a nonresponder and was further managed with endobronchial adrenaline. All 20 patients of the cold saline±adrenaline group were responders. No significant statistical difference was found between both groups with regard to systolic and diastolic blood pressures, heart rate, and oxygen saturation either before or after bronchoscopy. However, heart rate significantly increased after bronchoscopy both in the first (P<0.001) and the second group (P=0.007). Systolic blood pressure increased significantly (P=0.001) after bronchoscopy in the second group only. The amount of bronchoscopy-induced bleeding as well as the time required for bronchoscopic hemostasis significantly and directly correlated with the dose of TA (r=0.535, P=0.015, and r=1.000, P<0.001, respectively) and cold saline±adrenaline (r=0.687, P=0.33, r=0.858, P<0.001, respectively). TA did not result in any intrabronchoscopic and postbronchoscopic drug-related complications in any of the patients. Conclusion Endobronchial installation of TA is an effective and safe modality of treatment for controlling nonlife-threatening bronchopulmonary bleeding.

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