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Bronchoscopic instillation of tranexamic acid to control bronchopulmonary bleeding



Tranexamic acid (TA), a potent antifibrinolytic agent, has the potency to stop bleeding in a variety of medical and surgical conditions. However, its role in controlling airway bleeding is not yet proven. This study aimed to evaluate the efficacy of endobronchial administration of TA in controlling bronchopulmonary bleeding.

Materials and methods

A prospective, comparative, observational study was carried out including 40 patients scheduled to undergo bronchoscopy. For management of hemoptysis or bronchoscopy-induced bleeding, patients were randomly subdivided into two groups of 20 patients each: the first group received endobronchial TA, whereas the second group received endobronchial cold saline±adrenaline.


In the TA group, 19 patients were responders and only one patient was a nonresponder and was further managed with endobronchial adrenaline. All 20 patients of the cold saline±adrenaline group were responders. No significant statistical difference was found between both groups with regard to systolic and diastolic blood pressures, heart rate, and oxygen saturation either before or after bronchoscopy. However, heart rate significantly increased after bronchoscopy both in the first (P<0.001) and the second group (P=0.007). Systolic blood pressure increased significantly (P=0.001) after bronchoscopy in the second group only. The amount of bronchoscopy-induced bleeding as well as the time required for bronchoscopic hemostasis significantly and directly correlated with the dose of TA (r=0.535, P=0.015, and r=1.000, P<0.001, respectively) and cold saline±adrenaline (r=0.687, P=0.33, r=0.858, P<0.001, respectively). TA did not result in any intrabronchoscopic and postbronchoscopic drug-related complications in any of the patients.


Endobronchial installation of TA is an effective and safe modality of treatment for controlling nonlife-threatening bronchopulmonary bleeding.


  1. Dweik RA, Stoller, JK. Role of bronchoscopy in massive hemoptysis. Clin Chest Med 1999; 20:89–105

    Article  CAS  Google Scholar 

  2. Sternbach G, Varon J. Massive haemoptysis. Intensive Care World 1995; 12:74–78.

    Google Scholar 

  3. Sahebjami H. Iced saline lavage during bronchoscopy. Chest 1976; 69:131–132.

    Article  CAS  Google Scholar 

  4. Wellington K, Wagstaff AJ. Tranexamic acid: a review of its use in the management of menorrhagia. Drugs 2003; 63:1417–1433.

    Article  CAS  Google Scholar 

  5. Solomonov A, Fruchter O, Zuckerman T, Brenner B, Yigla M. Pulmonary hemorrhage: a novel mode of therapy. Respir Med 2009; 103:1196–1200.

    Article  Google Scholar 

  6. Waxman AB. Flexible bronchoscopy: indications, contraindications, and consent. In: Ernst A, editor. Introduction to bronchoscopy. New York: Cambridge University Press; 2009. pp. 78–85.

  7. Márquez-Martín E, Vergara DG, Martín-Juan J, Flacón AR, Lopez-Campos JL, Rodríguez-Panadero F. Endobronchial administration of tranexamic acid for controlling pulmonary bleeding: a pilot study. J Bronchology Interv Pulmonol 2010; 17:122–125.

    Article  Google Scholar 

  8. Prakash UBS, Freitag L. Hemoptysis and bronchoscopy-induced hemorrhage. In: Prakash UBS, editor. Bronchoscopy. Philadelphia, PA: Lippincott-Raven; 1997. pp. 227–251.

  9. Efrati O, Ben-Abraham R, Barak A, Paret G. Endobronchial adrenaline: should it be reconsidered? dose response and haemodynamic effect in dogs. Resuscitation 2003; 59:117–122.

    Article  CAS  Google Scholar 

  10. Mall W, Abel H. Topical application of epinephrine during bronchoscopy in barbiturate-halothane anesthesia and its influence on cardiac action. Bronchopneumologie 1978; 28:311–316.

    CAS  PubMed  Google Scholar 

  11. Khoo KL, Lee P, Mehta AC. Endobronchial epinephrine: confusion is in the air. Am J Respir Crit Care Med 2013; 187:1137–1138.

    Article  Google Scholar 

  12. Shofer S, Wahidi MM. Transbronchial lung biopsy. In: Ernst A, editor. Introduction to bronchoscopy. New York: Cambridge University Press; 2009. pp. 98–107.

    Google Scholar 

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Correspondence to Iman H. Galal MD, PhD.

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Korraa, E.ED.A., Madkour, A.M., Galal, I.H. et al. Bronchoscopic instillation of tranexamic acid to control bronchopulmonary bleeding. Egypt J Bronchol 11, 244–249 (2017).

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