# Combined Nebulized and IV Tranexamic Acid for Hemoptysis Management: A Case Report and Brief Literature Review

## TL;DR

Combined nebulized and IV tranexamic acid successfully controlled non-life-threatening hemoptysis in two patients without major side effects.

## Contribution

Demonstrates the potential of combined nebulized and systemic tranexamic acid as a noninvasive treatment for hemoptysis.

## Key findings

- Two patients with hemoptysis were successfully treated with combined nebulized and IV tranexamic acid.
- Nebulized TXA showed localized action with minimal systemic absorption and no recurrence of bleeding.
- Literature review suggests nebulized TXA has a high success rate with rare but notable side effects.

## Abstract

Hemoptysis management may necessitate invasive interventions, but combined nebulized and intravenous tranexamic acid (TXA) can play a promising noninvasive role in controlling hemoptysis. This case report describes two patients with non‐life‐threatening hemoptysis (a 71‐ and a 69‐year‐old man) successfully treated with combined nebulized and systemic IV TXA. A 71‐year‐old man with COPD exacerbation and non‐life‐threatening hemoptysis was successfully treated with TXA (both IV and nebulized) and standard care, which controlled the bleeding without adverse events or recurrence, and was discharged after 7 days. A 69‐year‐old male with bronchiectasis exacerbation experienced non‐life‐threatening hemoptysis. He was successfully treated with IV and nebulized TXA along with standard care, resolving the hemoptysis without recurrence and discharging the patient 8 days after admission. Existing evidence supports nebulized TXA's localized action, minimizing systemic absorption and thrombotic risks, though its efficacy on hemoptysis remains unproven. A brief review of 30 cases highlights nebulized TXA's high success rate with doses ranging from 250 to 2000 mg, though rare side effects like bronchospasm and serotonin‐like syndrome warrant caution. Playing a role as a potential alternative approach for antifibrinolytic administration in hemoptysis, especially for high‐thrombotic‐risk patients, and serving as a vital stabilization and bridging strategy before definitive interventional procedures, could be the main area for future studies.

(A and B) Sections of spiral lung CT scan reveal mosaicism and bronchial wall thickening; (C) Bronchoscopic view of intermediate bronchus reveals bronchial erythema.