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Abstract

We thank Messika et al for their comments on our study1Wand O. Guber E. Guber A. et al.Inhaled tranexamic acid for hemoptysis treatment: a randomized controlled trial.Chest. 2018; 154: 1379-1384Abstract Full Text Full Text PDF PubMed Scopus (56) Google Scholar and their suggestions regarding further investigation of the effect of nebulized tranexamic acid (TA) for hemoptysis treatment. Although there has been evidence of TA being effective in controlling bleeding,2Segrelles Calvo G. De Granda-Orive I. Lopez Padilla D. Inhaled tranexamic acid as an alternative for hemoptysis treatment.Chest. 2016; 149: 604Abstract Full Text Full Text PDF PubMed Scopus (27) Google Scholar no previous randomized controlled trials have been conducted. Therefore, the success rate of 90% was set based on our lengthy previous experience with the off-label use of this therapy, in addition to evidence from the literature.3Solomonov A. Fruchter O. Zuckerman T. et al.Pulmonary hemorrhage: a novel mode of therapy.Respir Med. 2009; 103: 1196-1200Abstract Full Text Full Text PDF PubMed Scopus (73) Google Scholar This was a single-center study and patient recruitment was slower than originally anticipated. Since the beginning of January 2012, 47 patients were recruited. After statistical consultation that confirmed sufficient power for that cohort, interim results were assessed. When a clear superiority of TA over placebo was reported in a number of parameters, we found it not ethical to continue the randomized study. The authors note the differences in the number of patients harboring bronchiectasis in the TA group between Tables 1 and 2. To clarify, in Table 1, we summarized the patients’ medical history on admission, whereas in Table 2, we reported the cause of hemoptysis after the hospital stay. The difference results from identifying new diagnoses during the hospital stay, such as establishing the presence of previously undiagnosed bronchiectasis by a chest CT scan. We agree that chest CT scan has an important role in managing patients presenting with hemoptysis.4Cordovilla R. Bollo de Miguel E. Nunez Ares A. et al.Diagnosis and treatment of hemoptysis.Arch Bronconeumol. 2016; 52: 368-377Crossref PubMed Scopus (45) Google Scholar, 5Gavelli F. Patrucco F. Statti G. et al.Mild-to-moderate hemoptysis: a diagnostic and clinical challenge.Minerva Med. 2018; 109: 239-247PubMed Google Scholar However, it may be unnecessary in cases in which the source of bleeding is already known, such as a preexisting tumor or bronchiectasis. The management of patients with hemoptysis is challenging and requires close supervision. We also find the long-term beneficial effect of nebulized TA intriguing. Unfortunately, the extended analysis of long-term possible cofounders, such as disease evolution or resumption of anticoagulant or antiplatelet medication, was not included in the study design, and is now difficult to obtain retrospectively. One can assume that the successful and timely control of the bleeding might have led to a change of course for the future management of these patients, with less reluctance in administering aggressive therapy. However, there are not sufficient data to support that hypothesis. We recognize the limitations of our study.1Wand O. Guber E. Guber A. et al.Inhaled tranexamic acid for hemoptysis treatment: a randomized controlled trial.Chest. 2018; 154: 1379-1384Abstract Full Text Full Text PDF PubMed Scopus (56) Google Scholar However, the consistency of the results over several outcome parameters makes our findings robust and significant. In conclusion, we can all agree that as always caution, as well as further study, is important. Tranexamic Acid Inhalations in Nonmassive Hemoptysis: A Word of CautionCHESTVol. 155Issue 4PreviewWe read with great interest the publication by Wand et al1 in a recent issue of CHEST (December 2018) regarding the efficacy of tranexamic acid (TA) inhalations in nonmassive hemoptysis. The main finding was that TA inhalations can be used safely and effectively to control bleeding in this setting. However, some issues need to be clarified. Full-Text PDF Inhaled Tranexamic Acid for Hemoptysis Treatment: A Randomized Controlled TrialCHESTVol. 154Issue 6PreviewTranexamic acid (TA) is an antifibrinolytic drug currently used systemically to control bleeding. To date, there have been no prospective studies of the effectiveness of inhaled TA for the treatment of hemoptysis. Full-Text PDF