Introduction: The management of severe hemoptysis mainly consists of invasive interventional procedures, including angiographic bronchial artery embolization, various endobronchial interventions, and sometimes surgery. However, there are limited effective noninvasive medical therapies available. The objective of this analysis was to evaluate the effectiveness and safety of nebulized tranexamic acid (TXA) administration compared with conventional management in patients with hemoptysis. Methods: This Institutional Review Board-approved, single-center, retrospective matched cohort study was performed from January 1, 2018 to March 31, 2021. Electronic health record data were used to identify all adult inpatients with hemoptysis (International Classification of Diseases, Tenth Revision, code R04.2). All patients who received ≥1 dose of nebulized TXA were matched with up to five controls based on available severity criteria (hemoptysis severity, need for mechanical ventilation, and sequential organ failure assessment score at the time of hemoptysis diagnosis) with coarsened exact matching. The primary outcome was the need for invasive interventions for the management of hemoptysis. Secondary outcomes included time to hemoptysis resolution, duration of mechanical ventilation, hemoptysis recurrence, and hospital length of stay. Results: A total of 14 patients were treated with nebulized TXA; they were matched with 58 controls. Patients were 59.7% male, had a median age of 65.5 years, with airway disease (36.1%) being the major etiology of hemoptysis. There was no difference in the number of patients who required an invasive intervention between the TXA (35.7%) versus control group (56.9%), p = 0.344. Additionally, no difference was found in the time to hemoptysis resolution (p = 0.050), duration on mechanical ventilation (p = 0.128), hemoptysis recurrence (p = 1.000), or hospital length of stay (p = 0.139). Conclusions: In patients with hemoptysis, nebulized TXA may be considered as a noninvasive option for the management of hemoptysis. However, a larger analysis is warranted to determine the impact of nebulized TXA on invasive interventions for management.

中文翻译：

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三级学术医疗中心雾化氨甲环酸对中度至大量咯血患者的疗效。

简介：严重咯血的治疗主要包括侵入性介入治疗，包括血管造影支气管动脉栓塞术、各种支气管内介入治疗，有时还包括手术治疗。然而，有效的非侵入性医学疗法有限。本分析的目的是评估与常规治疗相比，雾化氨甲环酸 (TXA) 治疗咯血患者的有效性和安全性。方法：这项经机构审查委员会批准的单中心回顾性配对队列研究于2018年1月1日至2021年3月31日进行。电子健康记录数据用于识别所有成年咯血住院患者（国际疾病分类，第十版）修订版，代码 R04.2）。根据现有的严重程度标准（咯血严重程度、机械通气需求以及咯血诊断时的序贯器官衰竭评估评分），所有接受≥1剂量雾化TXA的患者与最多五名对照者进行粗略精确匹配。主要结果是需要侵入性干预措施来治疗咯血。次要结局包括咯血缓解时间、机械通气持续时间、咯血复发和住院时间。结果：共有14例患者接受了TXA雾化治疗；他们与 58 个对照相匹配。患者中59.7%为男性，中位年龄为65.5岁，气道疾病（36.1%）是咯血的主要病因。TXA 组 (35.7%) 与对照组 (56.9%) 之间需要侵入性干预的患者数量没有差异，p = 0.344。此外，咯血缓解时间 (p = 0.050)、机械通气持续时间 (p = 0.128)、咯血复发 (p = 1.000) 或住院时间 (p = 0.139) 也没有发现差异。结论：对于咯血患者，雾化 TXA 可被视为治疗咯血的无创选择。然而，需要进行更大规模的分析来确定雾化 TXA 对侵入性干预治疗的影响。