C53-43 When Every Breath Counts: Controlling Hemoptysis With Nebulized Tranexamic Acid

Abstract Introduction Hemoptysis, the expectoration of blood from the respiratory tract, can arise from various causes, which can be life-threatening. Standard treatment includes bronchoscopy, bronchial artery embolization, and resection. Tranexamic acid (TXA), an antifibrinolytic, inhibits plasmin-mediated clot degradation and is commonly used for systemic bleeding. Although typically administered intravenously or orally, nebulized TXA has emerged as a potential off-label treatment for hemoptysis by delivering high concentrations directly to the bleeding site with minimal systemic exposure. We describe a case of the use of nebulized TXA for severe hemoptysis in a patient with advanced oropharyngeal carcinoma after conventional measures failed. Description A 66-year-old male with a history of chronic smoking and moderately differentiated keratinizing squamous cell carcinoma of the oropharynx post tracheostomy, undergoing chemoradiation, presented with dyspnea and multiple episodes of hemoptysis from the mouth and tracheostomy tube. Upon arrival, he was hemodynamically stable with a hemoglobin (Hgb) level of 8.2 g/dL and a hematocrit of 26.8%. Chest radiography showed no acute pathology. CT angiography of the chest, abdomen, and pelvis eliminated aortic dissection. Still, it revealed patchy and nodular ground-glass opacities in the middle and bilateral lower lobes, suggestive of aspiration or alveolar hemorrhage. He was admitted to the intensive care unit for close respiratory monitoring. One day into hospital stay, hemoptysis persisted, with Hgb falling to 6.9 g/dL; he received one unit of packed red blood cells, raising Hgb to 9.3 g/dL. A CT angiogram of the neck showed progression of the carcinoma, but no active extravasation. A bronchoscopy revealed no bleeding source, with recurrent episodes of brisk hemoptysis causing Hgb to drop to 7.3g/dL. Given ongoing bleeding despite transfusion, TXA (injectable solution, off-label) was administered via nebulizer, with hemoptysis subsiding significantly with no further transfusions. Discussion Nebulized tranexamic acid (TXA) is a promising off-label treatment for severe hemoptysis, particularly in complex cases where the source of bleeding is unknown and standard methods are limited. In this specific case, the patient’s severe hemoptysis was likely caused by the friable tumor mucosa or diffuse alveolar hemorrhage rather than a major vessel and was successfully managed with nebulized TXA. The TXA worked by stabilizing clots through its antifibrinolytic effect. This method is advantageous because it may maximize local hemostatic efficacy while minimizing systemic side effects. Although more research is needed to determine optimal dosing, this case supports the use of nebulized TXA in challenging clinical presentations. This abstract is funded by: None