G. Glodić*a (Dr), I. Sabolb (Dr), F. Džubura (Dr), M. Janković Makeka (Dr), D. Baričevića (Dr), M. Koršića (Dr), F. Popovića (Dr), D. Srdića (Dr), M. Samaržijaa (Prof), S. Badovinaca (Dr)

a University Hospital Centre Zagreb, Zagreb, CROATIA ; b Ruđer Bošković Institute, Zagreb, CROATIA

* glodic.goran@gmail.com

Background: The most commonly used topical hemostatic agents during flexible bronchoscopy (FB) are cold saline and adrenaline. Although widely used for hemostasis in trauma and surgery, data supporting the use of tranexamic acid (TXA) for endobronchial bleeding are limited. Our aim was to compare the efficacy of topical TXA versus adrenaline in controlling iatrogenic bleeding during FB.

Methods: we conducted a cluster-randomized, double blind, single center trial in a tertiary teaching hospital. Following hemostasis 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).

Results: During the study period 2033 FB were performed with 575 bleeding episodes (mean VAS 3.6± 1.3). Bleeding was stopped with cold saline in 432 patients (75.1%). A total of 142 patients were randomized to adrenaline (N=67) or TXA (N=75), and after excluding 12 patients for protocol violation, 130 patients were included in the final analysis. There was no difference in the 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 = 4.9 ± 1.3, N=1.8 ± 0.8; TXA mean VAS = 5.3 ± 1.4, N= 1.8 ± 0.8). We recorded no drug related adverse events.

Conclusion: We found no significant difference between adrenaline and TXA for controlling iatrogenic endobronchial bleeding, thus adding to the body of evidence that TXA could be used safely and effectively during FB.

Disclosure of funding source(s): none