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IV TXA for Hemoptysis

January 3, 2020

Written by Sam Parnell

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Intravenous tranexamic acid (TXA) may reduce in-hospital mortality, length of stay, and total healthcare costs for patients admitted with hemoptysis.

Why does this matter?
Hemoptysis is a sphincter tightening disease associated with significant morbidity and mortality.  Management of hemoptysis consists primarily of interventional procedures to stop hemorrhage. There are few medical treatment options. Inhaled (TXA) has recently shown promise. How about IV TXA?

TXA: A Panacea for Hemoptysis?
This was a retrospective observational study of 28,539 patients from Japan comparing in-hospital mortality for patients with hemoptysis who received IV TXA on the day of hospital admission to those that did not.  After propensity score matching two groups with 9,933 patients each, administration of IV TXA was associated with lower in-hospital mortality (11.5% vs. 9.0%; p < 0.001), shorter hospital stay (18 ± 24 days vs. 16 ± 18 days; p < 0.001), and lower total healthcare costs ($7,573 ± 10,085 vs. $6,757 ± 9,127; p < 0.001). Adverse effects such as venous thromboembolism and seizure were rare and not significantly increased in the TXA group. Limitations include the retrospective and observational nature of the study, possible unmeasured confounders, and patient crossover among the treatment groups. In addition, the time from symptom onset to the initiation of TXA was not measured, and the temporal effect of TXA for patients with hemoptysis is currently unknown. Nevertheless, this study suggests that IV TXA may be a cost effective and safe therapy that could decrease mortality for patients with hemoptysis. TXA may not be a panacea for hemoptysis, but both IV and inhaled TXA may be useful adjuncts for a serious disease with few other proven medical therapies.

Effect of tranexamic acid on mortality in patients with haemoptysis: a nationwide study. Crit Care. 2019 Nov 6;23(1):347. doi: 10.1186/s13054-019-2620-5.

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Reviewed by Clay Smith

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