Inhaled Tranexamic Acid for Non-Massive Haemoptysis in a Riv
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Haemoptysis is the expectoration of blood originating from the respiratory tract and occurs secondary to infection, malignancy, bronchiectasis or vascular disease. Its severity varies from minimal blood-streaked sputum to life-threatening haemorrhage. Therefore, prompt evaluation of the cause of the haemoptysis and its severity, and timely management are crucial. Although there is still no effective therapy for haemoptysis apart from treating the cause, inhaled tranexamic acid (TXA) might have a potential role in controlling non-massive haemoptysis.

Authors present the case of 63-year-old man with COPD/bronchiectasis and atrial fibrillation who was on rivaroxaban. The patient presented to hospital with complains of shortness of breath, fever and desaturation. He was admitted as a case of acute exacerbation of COPD/bronchiectasis, secondary to pseudomonas infection. He received anti-pseudomonal antibiotics and a 5-day course of steroids. His condition improved but he was dependent on oxygen and bilevel positive airway pressure (BiPAP) therapy as he had chronic CO2 retention with PCO2 of 94, and it was difficult for him to return home until a BIPAP device and oxygen could be provided for him there.

On the 15th day of his stay, the patient developed mild haemoptysis which was attributed to be secondary to complications of bronchiectasis while he was on a direct oral anticoagulant (DOAC). Consequently, rivaroxaban was stopped for 1 day and the patient was closely observed. As his haemoptysis had not improved the next day, he was started on oral TXA 1 g every 8 hours which he continued to receive for 4 days during which time there was no significant improvement in his haemoptysis.

The patient was then changed to inhaled nebulized TXA 500 mg every 8 hours. After 24 hours the patient noted improvement in his symptoms which completely resolved after 48 hours. He had a CT scan which showed mainly upper lobe cystic and varicoid bronchiectasis in both lungs. He was restarted on a DOAC and did not report any other episodes of haemoptysis during 10 days of observation in hospital.