Department of Radiology, Soonchunhyang University College of Medicine, Cheonan Hospital, Cheonan-si, Republic of Korea.
Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Acta Radiol. 2021 May;62(5):610-618. doi: 10.1177/0284185120933984. Epub 2020 Jun 17.
While most previous studies have viewed tranexamic acid as a bridging or temporary therapy, our preliminary study offers insights into the combined therapy of antifibrinolytic agent with endovascular treatment for hemoptysis.
To investigate the feasibility and safety of combined therapy, to analyze factors affecting the outcomes of combined therapy, and to compare the effectiveness of combined therapy between groups with different etiologies.
Between January 2011 and December 2014, 64 patients (33 men, mean age 64.6 years) underwent combined therapy for hemoptysis. The median follow-up time was 14.7 months (range 174-2435 days). Patients were divided into a tuberculosis group (Group, n=37) and a non-tuberculosis group (Group, n=27).
Embolotherapy was technically successful in 62/64 (96.9%) cases. The immediate clinical success rate was 96.8% (60/62). The short-term and long-term recurrence rates were 12.9% (n=8) and 19.4% (n=12), respectively. The one-, two-, and four-year recurrence-free survival rates were 61%, 49%, and 32%, respectively. There was no significant survival difference between the two groups. Suboptimal embolization was a significant risk factor for immediate clinical failure (odds ratio 29.624, = 0.023). Optimal embolization (hazard ratio [HR] 0.199, = 0.023) and older age (HR 0.956, = 0.013) were significantly associated with lower recurrence risk.
Combined therapy is an effective and safe treatment modality for hemoptysis of various etiologies, with potential benefits for short-term recurrence vis-a-vis current literature evidence. Suboptimal embolization was the most important modifiable risk factor for treatment failure and recurrence after combined therapy.
虽然大多数先前的研究将氨甲环酸视为桥接或临时治疗方法，但我们的初步研究提供了关于纤维蛋白溶解抑制剂与血管内治疗联合治疗咯血的见解。
探讨联合治疗的可行性和安全性，分析影响联合治疗效果的因素，并比较不同病因组联合治疗的效果。
2011 年 1 月至 2014 年 12 月，64 例患者（33 名男性，平均年龄 64.6 岁）接受联合治疗咯血。中位随访时间为 14.7 个月（范围 174-2435 天）。患者分为结核组（n=37）和非结核组（n=27）。
64 例患者中，62 例（96.9%）的栓塞治疗技术成功。即刻临床成功率为 96.8%（60/62）。短期和长期复发率分别为 12.9%（n=8）和 19.4%（n=12）。1、2、4 年无复发生存率分别为 61%、49%和 32%。两组之间无明显生存差异。栓塞不完全是即刻临床失败的显著危险因素（优势比 29.624，P=0.023）。最佳栓塞（风险比 [HR] 0.199，P=0.023）和年龄较大（HR 0.956，P=0.013）与较低的复发风险显著相关。
联合治疗是治疗各种病因咯血的有效且安全的治疗方法，与当前文献证据相比，联合治疗在短期复发方面具有潜在的益处。栓塞不完全是联合治疗后治疗失败和复发的最重要可改变危险因素。
