Bronchoscopic Endobronchial Application of Tranexamic Acid in Bronchopulmonary Bleeding
Ibrahim Mohamed Ibrahim ELsaidy;
Abstract
SUMMARY
B
ronchoscopy may be of value in hemoptysis for several reasons: to identify site of bleeding, to provide endobronchial therapy to reduce or stop bleeding, to clear blood clots that might impair gas exchange.
In attempts to cease bleeding, iced saline or an epinephrine solution can be instilled into a bleeding airway or applied topically onto a proximal bleeding site in attempt to induce vasoconstriction.
There are potential systemic adverse events related to use of adrenaline e.g. tachyarrhythmia, vasoconstriction and hypertension. Moreover, when administered into the lung periphery, epinephrine can even lead to a potentially fatal arrhythmia.
Tranexamic acid is a simple little molecule, just a synthetic derivative of the amino acid lysine. But it’s also a potent pro-haemostatic drug that binds plasminogen and plasmin and stops the degradation of fibrin (the stuff in blood clots).
The current study was done to evaluate the therapeutic effect of endobronchial administration of TA in control of bronchopulmonary bleeding versus cold saline + adrenaline. It was a comparative study.
In the period between March 2016 and December 2016, 40 patients were recruited from bronchoscopy unit of Ain shams university hospital and the national institute of chest diseases at Embaba.
All patients were evaluated clinically and radiologically in addition to baseline hemoglobin concentration and bleeding profile. Also vital signs were recorded before and after bronchoscopy to all patients.
The following results were obtained:
- NO significant difference between the two groups as regards demographic data.
- The cause of airway bleeding was either spontaneous or bronchoscopic procedure induced.
- 5 out of 20 patients in the cyclokapron group presented with spontaneous bleeding and none of the cold saline and adrenaline group presented with spontaneous bleeding.
- Bleeding arrest was successful in 95% of patients in cyclokapron group (19 out of 20 patients) and was successful in 100% of patients in cold saline and adrenaline group (20 patients).
- Adrenaline use was associated with increased systolic blood pressure significantly and development of arrhythmia in 1 out of 20 patients (5%), while cyclokapron use wasn’t associated with significant complications.
- Malignancy was the most common cause of bleeding in both groups.
B
ronchoscopy may be of value in hemoptysis for several reasons: to identify site of bleeding, to provide endobronchial therapy to reduce or stop bleeding, to clear blood clots that might impair gas exchange.
In attempts to cease bleeding, iced saline or an epinephrine solution can be instilled into a bleeding airway or applied topically onto a proximal bleeding site in attempt to induce vasoconstriction.
There are potential systemic adverse events related to use of adrenaline e.g. tachyarrhythmia, vasoconstriction and hypertension. Moreover, when administered into the lung periphery, epinephrine can even lead to a potentially fatal arrhythmia.
Tranexamic acid is a simple little molecule, just a synthetic derivative of the amino acid lysine. But it’s also a potent pro-haemostatic drug that binds plasminogen and plasmin and stops the degradation of fibrin (the stuff in blood clots).
The current study was done to evaluate the therapeutic effect of endobronchial administration of TA in control of bronchopulmonary bleeding versus cold saline + adrenaline. It was a comparative study.
In the period between March 2016 and December 2016, 40 patients were recruited from bronchoscopy unit of Ain shams university hospital and the national institute of chest diseases at Embaba.
All patients were evaluated clinically and radiologically in addition to baseline hemoglobin concentration and bleeding profile. Also vital signs were recorded before and after bronchoscopy to all patients.
The following results were obtained:
- NO significant difference between the two groups as regards demographic data.
- The cause of airway bleeding was either spontaneous or bronchoscopic procedure induced.
- 5 out of 20 patients in the cyclokapron group presented with spontaneous bleeding and none of the cold saline and adrenaline group presented with spontaneous bleeding.
- Bleeding arrest was successful in 95% of patients in cyclokapron group (19 out of 20 patients) and was successful in 100% of patients in cold saline and adrenaline group (20 patients).
- Adrenaline use was associated with increased systolic blood pressure significantly and development of arrhythmia in 1 out of 20 patients (5%), while cyclokapron use wasn’t associated with significant complications.
- Malignancy was the most common cause of bleeding in both groups.
Other data
| Title | Bronchoscopic Endobronchial Application of Tranexamic Acid in Bronchopulmonary Bleeding | Other Titles | استخدام حمض الترانيكزاميك عن طريق المنظار فى وقف النزيف الشعبي الرئوي | Authors | Ibrahim Mohamed Ibrahim ELsaidy | Issue Date | 2017 |
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