BRONCHOSCOPIC ADMINISTRATION OF TRANEXAMIC ACID FOR AIRWAY BLEEDING INCLUDING PATIENTS ON ECMO: A TERTIARY REFERRAL CENTER EXPERIENCE

TYPE: Abstract Publication TOPIC: Procedures PURPOSE: Fiberoptic bronchoscopy (FB) is critical to diagnose and treat airway bleeding, particularly in patients on extracorporeal membrane oxygenation (ECMO).Tranexamic acid (TXA) has been efficacious in reducing bleeding, particularly in surgical patients. We report the use of TXA instillation as a promising adjunct to treat airway bleeding. METHODS: All adult patients presenting to our tertiary referral center with pulmonary hemorrhage from January 2015 to December 2019 were reviewed for bronchoscopy and subsequent treatments. Data were collected on demographics, diagnosis, ECMO, anticoagulation, and FB. RESULTS: During this time, 4,161 patients had a diagnosis of hemoptysis and 1,467 underwent FB. Of these, 19 patients received TXA delivered via FB (1.3%). The concentration and dosage of TXA used varied between patients (5mg to 1000mg). Five of those patients were on ECMO, none of whose anticoagulation was interrupted. Three of the five patients were noted to have improved or resolved bleeding after TXA (60%). Of the 14 non-ECMO patients, seven were on anticoagulation. 12 of the 14 achieved hemostasis after TXA (86%). All patients received other hemostatic techniques prior to TXA, with cold saline infusion being the most common (71%). There were no thrombotic complications in any patients. CONCLUSIONS: Although dosage of TXA varied between patients, it did improve bleeding and was deemed safe in achieving hemostasis. This is the first report detailing bronchoscopic TXA use in patients on ECMO. Further controlled studies are needed to standardize dosing and determine effectiveness. CLINICAL IMPLICATIONS: Bronchoscopic administration of TXA is safe and should be considered for therapy of complex airway bleeding cases. DISCLOSURE: No significant relationships. KEYWORDS: Tranexamic acid, Bronchoscopy, hemoptysis