Background

Although massive bleeding following transbronchial lung biopsies (TBLB) is rare, even minor hemorrhage may prolong the procedure and result in inadequate sampling. Tranexamic acid (TXA) is an antifibrinolytic agent, which reduces bleeding in numerous scenarios, however, its prophylactic use in mitigating post-TBLB bleeding has not been investigated. We conducted a prospective, randomized, double-blind, placebo-controlled trial to determine whether topical infusion of TXA prior to TBLB would reduce bleeding, shorten procedure duration and increase the number of biopsies obtained.

Methods

We blindly randomized patients undergoing TBLB to receive topical TXA or placebo in the lobar bronchus prior to biopsies. Vital signs, procedure length, fluid balance (as a measure of the amount of bleeding), operator's assessment of bleeding, and number of biopsies obtained were measured. Data was analyzed using the two-tailed Student's T-Test, Chi-square or Mann-Whitney tests as appropriate.

Results

Fifty patients were randomized, 26 to the TXA arm. The bleeding in the TXA group was significantly lower (P = 0.0037), with more specimens being obtained (placebo 7 (6, 9) (median and interquartile range) vs. TXA 9 (8, 10), P = 0.023) and no difference in procedure length (placebo 30 min (29.3, 34.3) vs. TXA 30 (24.8, 36), P = 0.90). There were no clinically significant adverse events in any of the groups up to one month of follow up.

Conclusion

Endobronchial installation of TXA prior to obtaining TBLB results in less bleeding and allows more biopsies to be obtained with no additional adverse events. The prophylactic use of TXA during TBLB may be considered as standard.

中文翻译：

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预防性使用氨甲环酸预防经支气管肺活检时的出血-一项随机，双盲，安慰剂对照试验

背景

尽管经支气管肺活检（TBLB）后发生大量出血的情况很少，但即使少量出血也可能延长手术时间并导致采样不足。氨甲环酸（TXA）是一种抗纤维蛋白溶解剂，可在多种情况下减少出血，但是，尚未研究其在减轻TBLB后出血中的预防作用。我们进行了一项前瞻性，随机，双盲，安慰剂对照试验，以确定在TBLB之前局部输注TXA是否会减少出血，缩短手术时间并增加活检的数量。

方法

我们对接受TBLB的患者进行盲法随机化，以在活检前在大叶支气管中接受局部TXA或安慰剂。测量了生命体征，手术时间，体液平衡（作为出血量的量度），操作者对出血的评估以及所获得的活检次数。适当时使用两尾学生T检验，卡方检验或曼惠特尼检验对数据进行分析。

结果

随机选择50例患者，其中26例归入TXA组。TXA组的出血明显更低（P  = 0.0037），获得的标本更多（安慰剂7（6，9）（中位数和四分位数范围）与TXA 9（8，10），P = 0.023），没有程序长度差异（安慰剂30分钟（29.3，34.3）与TXA 30（24.8，36），P = 0.90）。在随访的一个月内，任何一组均无临床上明显的不良事件。

结论

在获得TBLB之前在TXA的支气管内安装可减少出血，并可以进行更多的活检，而无其他不良事件。TBLB期间TXA的预防性使用可以视为标准。