Sydney Head and Neck Cancer Institute, Royal Prince Alfred Hospital, Camperdown, Australia.
Laryngoscope. 2013 Oct;123(10):2449-52. doi: 10.1002/lary.24064. Epub 2013 Apr 1.
OBJECTIVES/HYPOTHESIS: Symptomatic bleeding among patients with advanced upper aerodigestive tract tumor is a challenging problem. Given the limited options for topical treatment, embolization is often required to control the hemorrhage. There are recent reported cases of novel and successful treatment of patients with recalcitrant tracheo-bronchial bleed with tranexamic acid. We therefore described our initial experience of four consecutive cases of patients with bleeding from advanced aerodigestive tract tumor, successfully treated with oral tranexamic acid.
Case series.
Case series of four consecutive patients with acute bleed from upper aerodigestive tract tumors, treated with oral tranexamic acid. Tranexamic acid was administered topically and systemically (1gm PO QID) for the orophayngeal and supraglottic tumor cases, where as systemic-only therapy were administered to the patients with nasal and nasopharyngeal tumors.
None of the patients experienced further bleeding following the commencement of tranexamic acid treatment, and no adverse effect was noted. These are the first reported cases of symptomatic upper aerodigestive hemorrhage being controlled with tranexamic acid. It is increasingly being used in patients with life-threatening bleeding following trauma and major surgery. The optimum dose of tranexamic acid is undetermined. In vivo studies suggested concentrations of 10 μg/mL to 16 μg/mL for optimal anti-fibrinolytic effect, which is achievable with 1gm QID of oral administration. Large randomized controlled trials assessing the utility of tranexamic acid in various orthopedic surgeries did not show increased thromboembolic events.
Tranexamic acid should be considered for patients with symptomatic nonarterial bleeding of the upper aerodigestive tract tumors.
目的/假设：晚期上呼吸消化道肿瘤患者的症状性出血是一个具有挑战性的问题。鉴于局部治疗选择有限，通常需要栓塞来控制出血。最近有报道称，使用氨甲环酸成功治疗了顽固的气管 - 支气管出血的患者，这是一种新的治疗方法。因此，我们描述了我们对四例晚期上呼吸消化道肿瘤出血患者的初步经验，这些患者使用口服氨甲环酸成功治疗。
病例系列。
对四例因上呼吸消化道肿瘤急性出血而接受氨甲环酸治疗的连续患者进行病例系列研究。对口咽和声门上肿瘤病例，局部和系统给予氨甲环酸（1gm PO QID）治疗，而对鼻和鼻咽肿瘤患者，则给予系统治疗。
在开始使用氨甲环酸治疗后，没有患者出现进一步出血，也没有观察到不良反应。这些是首例使用氨甲环酸控制症状性上呼吸消化道出血的报道。它越来越多地用于创伤和大手术后危及生命的出血患者。氨甲环酸的最佳剂量尚未确定。体内研究表明，10 μg/mL 至 16 μg/mL 的浓度可达到最佳抗纤维蛋白溶解作用，这可以通过 1gm QID 的口服给药来实现。评估氨甲环酸在各种骨科手术中的效用的大型随机对照试验并未显示出血栓栓塞事件增加。
对于有症状的非动脉性上呼吸消化道肿瘤出血患者，应考虑使用氨甲环酸。
4 级。
