Merchant Alison, Lazarus Raynuka, Thompson Cassandra, Bishop Jennifer, Song Yang, Middleton Peter G
Australian Institute of Health Innovation, Macquarie University, New South Wales, Australia; Department of Respiratory and Sleep Medicine, Westmead Hospital, New South Wales, Australia.
Department of Respiratory and Sleep Medicine, Westmead Hospital, New South Wales, Australia.
Respir Med. 2025 Aug-Sep;245:108187. doi: 10.1016/j.rmed.2025.108187. Epub 2025 May 31.
Haemoptysis is common in adults with cystic fibrosis (CF). Tranexamic acid (TA), an antifibrinolytic agent, blocks the binding of plasminogen and plasmin to fibrin to inhibit clot breakdown. Despite its theoretical benefits, there is limited data on the use of inhaled TA for management of haemoptysis in CF.
A 3-year retrospective audit of inhaled TA in CF patients with haemoptysis was conducted. Baseline demographics, hospitalisation status, haemoptysis volume, adverse events, adjuvant therapies and time to resolution of haemoptysis were extracted. We report on the safety and efficacy of nebulised TA, and outline our hospital-specific protocol for its use.
Twenty-six adults [female, 12; age (yrs), 27.2 ± 3.1 95 % CI] with haemoptysis were trialled on nebulised TA, in addition to standard therapy. Nebulised TA was generally well tolerated; six patients reported chest tightness during dosing, which resolved in all cases with bronchodilators or a reduction in TA dose. In 65.4 % of cases, haemoptysis resolved within 48 h with TA use. A home haemoptysis management plan, with guidance for outpatient TA use was provided to 19 adults.
Nebulised TA is a well-tolerated, non-invasive and inexpensive pharmacological option for in- and outpatient management of haemoptysis in CF. Our data support the use of TA to minimise further bleeding in CF outpatients, while waiting for further intervention from their CF service. However, first-dose trials should be supervised to assess for safety and side effects, and a personalised home haemoptysis management plan should be provided prior to use.
咯血在成年囊性纤维化（CF）患者中很常见。氨甲环酸（TA）是一种抗纤溶药物，可阻断纤溶酶原和纤溶酶与纤维蛋白的结合以抑制血栓分解。尽管有理论上的益处，但关于吸入TA用于CF咯血管理的数据有限。
对CF咯血患者吸入TA进行了为期3年的回顾性审计。提取了基线人口统计学数据、住院状态、咯血量、不良事件、辅助治疗以及咯血缓解时间。我们报告雾化TA的安全性和有效性，并概述我们医院使用TA的特定方案。
26名咯血的成年人[女性12名；年龄（岁），27.2±3.1 95%CI]除接受标准治疗外，还试用了雾化TA。雾化TA总体耐受性良好；6名患者在给药期间报告有胸闷，所有病例通过使用支气管扩张剂或减少TA剂量后症状均得到缓解。在65.4%的病例中，使用TA后咯血在48小时内缓解。为19名成年人提供了家庭咯血管理计划以及门诊使用TA的指导。
雾化TA是CF患者门诊和住院期间咯血管理中耐受性良好、非侵入性且廉价的药理学选择。我们的数据支持使用TA减少CF门诊患者的进一步出血，同时等待CF专科服务的进一步干预。然而，首次给药试验应进行监督以评估安全性和副作用，并且在使用前应提供个性化的家庭咯血管理计划。
