Tranexamic Acid for Hemoptysis: A Review

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Tranexamic acid (TXA) is an antifibrinolytic agent used to promote hemostasis. TXA is widely used to arrest bleeding in trauma, perioperatively after cardiac surgery, for menorrhagia, and in hemophilia. Less attention has been given to using TXA to lessen hemoptysis, which is the subject of this systematic review. Three small, underpowered randomized controlled trials have examined the efficacy of TXA in hemoptysis. Two of these assessed intravenous TXA, one of which showed significant reduction in the severity and duration of hemoptysis. The third trial examined oral TXA for controlling hemoptysis and failed to show a significant reduction in the amount or duration of hemoptysis. Although inhaled TXA has been described in several case reports and small series, no trial has examined the efficacy of inhaled TXA. The weight of evidence suggests that systemic administration of TXA is safe and does not increase the risk for thrombosis; no adverse effects have been described in the few available reports of inhaled TXA. Overall, TXA is an underrecognized treatment that may have temporizing value in managing patients with nonmassive hemoptysis. In the context that the available literature is sparse, large, well-designed clinical trials are needed to advance understanding of the role of TXA in hemoptysis.

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