Effects of Tranexamic Acid on Hemoptysis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
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SYSTEMATIC REVIEW
Effects of Tranexamic Acid on Hemoptysis: A Systematic Review and Meta‑Analysis of Randomized Controlled Trials Yi‑San Tsai1,2,3 · Li‑Wen Hsu1 · Ming‑Shun Wu4 · Kee‑Hsin Chen1,5,6,7,8 · Yi‑No Kang6,8,9,10
© Springer Nature Switzerland AG 2020
Abstract Background Hemoptysis, a common symptom of different lung diseases, engenders shortness of breath and increased mortality. Tranexamic acid (TXA), a commonly used antifibrinolytic agent, can control bleeding. However, the effects of its use on pulmonary hemorrhage have rarely been discussed. Objective We conducted this systematic review and meta-analysis of randomized controlled trials (RCTs) of TXA for hemoptysis to investigate its effectiveness in reducing hemoptysis volume and duration. Methods We searched the Cochrane Library, Embase, PubMed (including MEDLINE), and Scopus databases for relevant RCTs. Two of the authors individually assessed study quality by using the Cochrane risk-of-bias (RoB) 2.0 tool, and the pooled results were evaluated using RevMan 5.3. Results We obtained 617 articles, of which four RCTs met eligibility criteria. The pooled results demonstrated no significant differences in bleeding duration or hemoptysis resolution between the TXA and control groups. Nevertheless, TXA use reduced bleeding volume (mean difference [MD] = − 56.21 mL; 95% CI − 94.70 to − 17.72 mL), further intervention risk (Peto odds ratio = 0.24; 95% CI 0.08–0.67; I2 = 0%), and length of hospital stay (MD = − 1.62 days; 95% CI − 2.93 to − 0.31; I2 = 0%). Conclusion TXA use was observed to reduce bleeding volume, further intervention risk, and length of hospital stay in patients with hemoptysis; however, our results may have low statistical power because of limited sample size. Additional large-scale RCTs are thus warranted to confirm the effectiveness and safety of TXA use.
1 Introduction Hemoptysis, a common symptom of lung and bronchial diseases, is defined as the expectoration of blood originating from the tracheobronchial tube or lung [1, 2], and can be divided into massive and non-massive hemoptysis according to volume of blood produced [1, 3]. The cutoff value for defining massive hemoptysis ranged widely from Yi-San Tsai and Li-Wen Hsu contributed equally to this manuscript. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s40261-020-00946-y) contains supplementary material, which is available to authorized users. * Kee‑Hsin Chen [email protected] * Yi‑No Kang [email protected] Extended author information available on the last page of the article
200 mL/24 h to 1000 mL/24 h [3–5]. The main causes of common hemoptysis include bronchiectasis, malignant lung tumors, bronchitis, and pneumonia [6, 7]. However, it is not easily diagnosed and handled in clinical practice because the cause of hemoptysis is complex [8]. Increased hemoptysis causes shortness of breath and increases mortality [9–13]. Specifically, hemoptysis of 100–300 mL causes 7–30% mortality within 24 h; this rate may increa
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