Nebulized tranexamic acid for recurring hemoptysis in critically ill patients: case series
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(2020) 13:45
International Journal of Emergency Medicine
CASE REPORT
Open Access
Nebulized tranexamic acid for recurring hemoptysis in critically ill patients: case series Fatimah Alabdrabalnabi* , Mohammed Alshahrani and Nadia Ismail
Abstract Background: Hemoptysis is a clinical condition encountered in the emergency department (ED) and must be managed and investigated urgently to maintain the patient’s hemostasis. The management of hemoptysis depends on treating the underlying cause. Tranexamic acid (TXA) is an anti-fibrinolytic drug used to systemically control bleeding. There are a few studies available that investigate the use of nebulized tranexamic acid for hemoptysis with contradictory results. Our paper demonstrates three cases where patients presented with significant hemoptysis and had significant improvement in symptoms following the administration of nebulized tranexamic acid. The overall need for blood transfusion was reduced. Results: Three patients presented to the emergency room for evaluation of hemoptysis. All three patients had different underlying pathologies resulting in their hemoptysis and were monitored in the ICU. Initial conventional medical therapies including the correction of coagulopathy and discontinuing offending agents were utilized for treatment. After persistent symptoms, nebulized TXA at a dose of 500 mg three times a day was administered. The patients were all discharged from the hospital with improvement in their symptoms. Conclusion: Tranexamic acid may be considered in the treatment of hemoptysis regardless of the underlying cause. This may be utilized pending further workup and investigation into the underlying source of the bleeding. Keywords: Anti-fibrinolytic agent, TXA, Tranexamic acid, Pulmonary bleeding, Pulmonary hemorrhage, Hemoptysis
Introduction Pulmonary hemorrhage (hemoptysis) results from a variety of causes that can lead to death and/or end with poor prognosis. Emergent interventions are required, but the treatment of hemoptysis depends on treating the underlying cause which may be difficult to uncover. Recently, the use of nebulized tranexamic acid has been utilized as an alternative treatment in case of nonmassive hemoptysis. The problem is there is not enough data for the nebulized TXA contrast to the oral, the intravenous, and the topical one which used in many * Correspondence: [email protected] Imam Abdulrahman Bin Faisal University and King Fahad University hospital, Dammam, Saudi Arabia
bleeding conditions. Also, the available studies regarding nebulized TXA are few and controversial. Managing hemoptysis is one of the most important conditions in the emergency department. Therefore, the use of nebulized TXA as a treatment option is important [1–3], since it is available, inexpensive, heat-stable, and cost-effective [4].
Case series Case 1
A 31-year-old female presented to the emergency department in King Fahad University hospital in Saudi Arabia with dyspnea. She was found to have an elevated D-dimer in her laboratory studies.
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