Nebulized Tranexamic Acid Therapy for Hemoptysis Associated with Submassive Pulmonary Embolism

• Published in: Journal of aerosol medicine and pulmonary drug delivery Vol. 33; no. 1; p. 12
• Main Authors: Dhanani, Jayesh A, Roberts, Jason, Reade, Michael C
• Format: Journal Article
• Language: English
• Published: United States 01-02-2020
• Subjects: Administration, Inhalation; Aged; Anticoagulants - administration & dosage; Antifibrinolytic Agents - administration & dosage; Hemoptysis - drug therapy; Hemoptysis - etiology; Heparin - administration & dosage; Humans; Male; Oxygen Inhalation Therapy; Pulmonary Embolism - complications; Pulmonary Embolism - drug therapy; Tranexamic Acid - administration & dosage; Treatment Outcome; nebulized; hemoptysis; pulmonary embolism; tranexamic acid
• ISSN: 1941-2703
• DOI: 10.1089/jamp.2019.1534

Hemoptysis and pulmonary embolism (PE) are life-threatening pulmonary emergencies that, when present together, create a therapeutic conundrum. We present an illustrative case of a 65-year-old man with unprovoked submassive PE and moderate hemoptysis due to pulmonary infarction. Hemoptysis precluded systemic anticoagulation. Failing a conservative management strategy, we administered nebulized tranexamic acid. After four doses of nebulized tranexamic acid 500 mg, 6 hours apart, hemoptysis had ceased. Systemic anticoagulation with intravenous heparin was then successfully commenced 12 hours after the last episode of hemoptysis. The patient was weaned off high-flow nasal oxygen therapy over the course of the next 5 days with no hemoptysis recurrence. Noting the absence of trial evidence, but good pharmacological rationale and our positive experience, we suggest tranexamic acid is a useful noninvasive treatment option for the management of such conditions. Consent for this publication was obtained from the patient.