EMedHome's Clinical Pearl
Despite narrow FDA-approved indications, the use of tranexamic acid for various types of bleeding is increasing. Nebulized TXA has the potential to be a rapidly available therapeutic option in the ED for hemoptysis, serving as primary therapy or as a bridge until more definitive therapies are arranged.
Nebulized TXA may be an attractive option for patients whose goals of care limit invasive interventions. A recent case report adds to the growing body of literature for the use of nebulized TXA as a rapidly available ED treatment for hemoptysis, as well as its use as a noninvasive therapeutic palliative care option in such cases. (J Emerg Med 2018 Mar 2. doi: 10.1016/j.jemermed.2018.01.029.)
Case reports typically describe a dose of 500 mg of nebulized TXA, which can be given every six to eight hours. Bleeding stopped in most reported cases after the first dose of nebulized TXA, and no adverse events related to the TXA were reported. (Chest 2016;149(2):604; J Palliat Med 2015;18:1060; Interact Cardiovasc Thorac Surg 2013;17:991.)
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This Month's Podcast
Amal Mattu, MD, and Colleagues: HIV and Heart Disease, Cancer and ED Liability, Hemorrhagic Shock, and Balanced Fluids: http://bit.ly/MattuEMN. Dr. Mattu is one of the premier speakers in emergency medicine, and a professor of emergency medicine and the vice chair of emergency medicine at the University of Maryland School of Medicine in Baltimore.
This Month's Video
Sergey Motov, MD: Top 10 2017 Adult EM Pain Articles that Might Change Your Practice: http://bit.ly/EMN-EMedHomeVideos. Dr. Motov is an assistant professor of clinical emergency medicine at SUNY Downstate Medical Center and the assistant emergency medicine residency director at Maimonides Medical Center, both in New York City.