Tranexamic acid reduces bleeding during transbronchial lung biopsies

Prophylactic use of the antifibrinolytic agent tranexamic acid results in less bleeding during transbronchial biopsies, allowing more specimens to be obtained with no additional adverse events, a study has found.

Fifty patients undergoing transbronchial lung biopsies were randomized to receive topical tranexamic acid (n=26) or placebo (n=24) in the lobar bronchus prior to the procedure. Researchers recorded vital signs, procedure length, fluid balance (as a measure of the amount of bleeding), operator's assessment of bleeding, and number of specimens obtained.

Compared with placebo, tranexamic acid resulted in significantly lower bleeding (p=0.0037), with the median biopsies obtained being higher by two (9, interquartile range, 8–10 vs 7, interquartile range, 6–9; p=0.023).

The procedure lasted a median of 30 minutes in both groups (p=0.90). There were no clinically significant adverse events in any of the groups up to 1 month of follow up.

While massive bleeding following transbronchial lung biopsies is rare, even minor haemorrhage may prolong the procedure and lead to inadequate sampling, according to the researchers.

Findings of the present study indicate that prophylactic use of tranexamic acid during transbronchial biopsies may be considered as standard, they added.

The drug has been widely used to minimize bleeding and exposure to allogeneic blood transfusion in major surgery and other numerous settings. It works by inhibiting plasminogen activation and fibrinolysis. [Haematologica 2020;105:1201-1205]