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A3402 - Nebulized Tranexamic Acid
Author Block: M. Abdelkader1, L. Tudor2; 1Wellspan- York Hospital, York, PA, United States, 2Pulmonary Critical Care, Wellspan- York Hospital, York, PA, United States.
Introduction:Tranexamic acid, an amino acid derivative, reversibly blocks binding sites on plasminogen, proving its utility in hemostasis. This makes it extremely appealing in surgery, where it is more commonly used systemically to prevent intraoperative blood loss or stop post-operative bleeding complications. Even in its topical application, tranexamic acid has been shown to decrease the need for blood transfusions in a systemic review, particularly in cardiothoracic, neurosurgical and orthopedic surgeries.
Summary:Through 2 cases, (nebulized) tranexamic acid conveyed a hemostatic property in patients with pulmonary hemorrhage.Our first patient is a 70-year-old male with past medical history significant for metastatic hepatocellular carcinoma with bilateral lung involvement, who presented for severe hypotension. Patient was resuscitated and intubated in the ED. He continued to deteriorate in the intensive care unit despite aggressive interventions, to the point of pulmonary hemorrhage, noted on chest imaging. Bright blood was suctioned from his endotracheal tube. Having exhausted all options and no definitive etiology for the hemorrhage, 500mg in 5mL of tranexamic was nebulized over 15 minutes and administered via the endotracheal tube. Almost immediately after completion of the first dose, there was no frank blood noted with suctioning of the endotracheal tube.The second case is of a 77-year-old female with past medical history of COPD, heart failure and renal insufficiency who was admitted to a tertiary center for shortness of breath but was eventually transferred for worsening hypoxia with significant findings of persistent patchy infiltrates on chest x-ray. On CT scan of the chest, there was mixed interstitial and airspace disease that favored the upper lobes bilaterally. Bronchoscopy was performed, but she developed significant hemorrhage post-biopsy. Patient remained intubated post-procedure, where frank blood was suctioned from the endotracheal tube even 24 hours status-post bronchoscopy. Patient was treated with 500mg of tranexamic acid in 5mL solution administered via nebulizer over 15 minutes. This second patient had similar results with rapid resolution of hemoptysis/ pulmonary hemorrhage.
Discussion:Although the systemic and topical utility of tranexamic have been studied and implemented particularly in perioperative bleeding, the nebulized administration of tranexamic acid may also hold promise. In our two cases of pulmonary hemorrhage due to different etiologies, the outcomes were in congruence to its hemostatic property. Granted, no cause and effect relationship can be drawn from this clinical application; however, it is extremely probable that further research in the utilization of (nebulized) tranexamic acid in patients with pulmonary hemorrhage would yield significantly positive outcomes.