Tranexamic acid versus adrenaline for controlling iatrogenic endobronchial bleeding: a double blind randomized control trial

Abstract

<b>Introduction:</b> The most commonly used topical haemostatic agents during flexible bronchoscopy (FB) are cold saline and adrenaline. Data on usage of other agents such as tranexamic acid (TXA) for this purpose are limited. <b>Aims and objectives:</b> to compare the efficacy of topical TXA versus adrenaline in controlling iatrogenic bleeding during FB. <b>Methods:</b> we conducted a cluster-randomized, double blind, single centre trial in a tertiary teaching hospital. Following haemostasis failure after 3 applications of cold saline (4°C, 5ml), patients were randomized to receive up to 3 applications of TXA (100mg, 2ml) or adrenaline (0.2mg, 2ml). If bleeding persisted, crossover was allowed (for up to 3 further applications) before proceeding with other interventions. Bleeding severity was graded by the bronchoscopist using a visual analogue scale (VAS; 1 - very mild, 10 - severe). <b>Results:</b> 2033 FB were performed during the study period with 563 bleeding episodes (mean VAS 2,82 ± 1,4). Bleeding was stopped with cold saline in 432 patients (76.7%). 130 patients were randomized to adrenaline (N=65) or TXA (N= 65). There were no differences in bleeding control rate between the groups - bleeding was stopped in 83.1% (54/65) and 83.1% (54/65) patients receiving adrenaline or TXA, respectively (p=1). The severity of bleeding and number of applications needed for bleeding control (N) were similar in both groups (adrenaline mean VAS = 4,94 ± 1,31, N=1.78 ± 0.79; TA mean VAS = 5,25 ± 1,44, N= 1.78 ± 0.79). <b>Conclusion:</b> The majority of bleeding during FB was successfully stopped with cold saline. TXA was not inferior to adrenaline in controlling moderately severe endobronchial bleeding.