Nebulized tranexamic acid for hemoptysis in critically and non-critically ill patients: A retrospective analysis.

IF 1.7 Q4 CRITICAL CARE MEDICINE
Journal of Critical Care Medicine Pub Date : 2025-07-31 eCollection Date: 2025-07-01 DOI:10.2478/jccm-2025-0031
Nancy Bethuel, Chris Naum, Cynthia Brown
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引用次数: 0

Abstract

Introduction: Hemoptysis is a commonly encountered diagnosis caused by blood originating from the respiratory tract. Current pharmacological guideline recommendations for treatment do not exist. Tranexamic acid is a synthetic anti-fibrinolytic used in the management of various bleeding complications. Tranexamic acid has gained popularity for the treatment of hemoptysis with limited side effect knowledge. Our aim is to describe the clinical characteristics of patients receiving nebulized tranexamic acid for hemoptysis and compare clinical outcomes to those of patients receiving supportive care.

Materials and methods: This is a retrospective descriptive analysis performed in medical and ICU units at three tertiary hospitals. All patients were hospitalized with hemoptysis between January 1st, 2018 - December 31st, 2021. Demographic information, severity variables, and clinical outcomes were collected from medical records. For statistical analysis, we used t-test for continuous variables, chi-square or fishers' exact test for categorical variables, and propensity analysis to adjust for disease severity and underlying medical conditions.

Results: 488 patients were identified; 96 received tranexamic acid. There were slightly more smokers in the no TXA group (p = 0.04) but otherwise the two groups were similar in terms of demographic characteristics. The average length of hospital and ICU stay, need for mechanical ventilation or bronchoscopy, and mortality were significantly higher in the tranexamic acid group (p<0.01). The propensity analysis showed higher odds of death with nebulized tranexamic acid use, OR 2.51 (1.56-4.02).

Conclusions: There appears to be an indication bias for tranexamic acid based on disease severity without an obvious improvement in clinical outcomes. Our analysis suggests that nebulized tranexamic acid for hemoptysis may be potentially harmful, and further larger prospective research is warranted.

Abstract Image

氨甲环酸雾化治疗危重和非危重患者咯血的回顾性分析。
简介:咯血是一种常见的诊断,由血液来自呼吸道。目前尚不存在有关治疗的药理学指南建议。氨甲环酸是一种合成抗纤溶剂,用于治疗各种出血并发症。氨甲环酸已被广泛用于治疗咯血,但对其副作用的了解有限。我们的目的是描述接受雾化氨甲环酸治疗咯血患者的临床特征,并将临床结果与接受支持性治疗的患者进行比较。材料和方法:这是一项回顾性描述性分析,在三家三级医院的内科和ICU病房进行。所有患者均于2018年1月1日至2021年12月31日期间因咯血住院。从医疗记录中收集人口统计信息、严重程度变量和临床结果。对于统计分析,我们对连续变量使用t检验,对分类变量使用卡方或fisher精确检验,并对疾病严重程度和潜在医疗条件进行倾向分析。结果:共发现488例患者;96例接受氨甲环酸治疗。无TXA组吸烟者略多(p = 0.04),但除此之外,两组在人口统计学特征方面相似。氨甲环酸组患者的平均住院时间和ICU住院时间、机械通气或支气管镜检查需求、死亡率均显著高于氨甲环酸组(p)。结论:氨甲环酸根据病情严重程度可能存在指征偏倚,但临床结果没有明显改善。我们的分析表明雾化氨甲环酸治疗咯血可能有潜在的危害,需要进一步进行更大规模的前瞻性研究。
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来源期刊
Journal of Critical Care Medicine
Journal of Critical Care Medicine CRITICAL CARE MEDICINE-
CiteScore
2.00
自引率
9.10%
发文量
21
审稿时长
11 weeks
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