Use of nebulised tranexamic acid in adult patients with cystic fibrosis: A retrospective audit

Alison Merchant; Raynuka Lazarus; Cassandra Thompson; Jennifer Bishop; Yang Song; Peter G Middleton

doi:10.1016/j.rmed.2025.108187

Use of nebulised tranexamic acid in adult patients with cystic fibrosis: A retrospective audit

Respir Med. 2025 May 31:245:108187. doi: 10.1016/j.rmed.2025.108187. Online ahead of print.

Authors

Alison Merchant¹, Raynuka Lazarus², Cassandra Thompson³, Jennifer Bishop⁴, Yang Song⁵, Peter G Middleton⁶

Affiliations

¹ Australian Institute of Health Innovation, Macquarie University, New South Wales, Australia; Department of Respiratory and Sleep Medicine, Westmead Hospital, New South Wales, Australia. Electronic address: alison.merchant@mq.edu.au.
² Department of Respiratory and Sleep Medicine, Westmead Hospital, New South Wales, Australia. Electronic address: raynuka.lazarus@health.nsw.gov.au.
³ Department of Respiratory and Sleep Medicine, Westmead Hospital, New South Wales, Australia; Sydney Medical School, University of Sydney at Westmead Hospital, New South Wales, Australia. Electronic address: cassandra.thompson@health.nsw.gov.au.
⁴ Department of Respiratory and Sleep Medicine, Westmead Hospital, New South Wales, Australia. Electronic address: jennifer.bishop@health.nsw.gov.au.
⁵ Department of Respiratory and Sleep Medicine, Westmead Hospital, New South Wales, Australia. Electronic address: yang.song@health.nsw.gov.au.
⁶ Department of Respiratory and Sleep Medicine, Westmead Hospital, New South Wales, Australia; Ludwig Engel Centre for Respiratory Research, The Westmead Institute for Medical Research, New South Wales, Australia; Sydney Medical School, University of Sydney at Westmead Hospital, New South Wales, Australia. Electronic address: peter.middleton@sydney.edu.au.

PMID: 40456472
DOI: 10.1016/j.rmed.2025.108187

Abstract

Background: Haemoptysis is common in adults with cystic fibrosis (CF). Tranexamic acid (TA), an antifibrinolytic agent, blocks the binding of plasminogen and plasmin to fibrin to inhibit clot breakdown. Despite its theoretical benefits, there is limited data on the use of inhaled TA for management of haemoptysis in CF.

Methods: A 3-year retrospective audit of inhaled TA in CF patients with haemoptysis was conducted. Baseline demographics, hospitalisation status, haemoptysis volume, adverse events, adjuvant therapies and time to resolution of haemoptysis were extracted. We report on the safety and efficacy of nebulised TA, and outline our hospital-specific protocol for its use.

Results: Twenty-six adults [female, 12; age (yrs), 27.2 ± 3.1 95 % CI] with haemoptysis were trialled on nebulised TA, in addition to standard therapy. Nebulised TA was generally well tolerated; six patients reported chest tightness during dosing, which resolved in all cases with bronchodilators or a reduction in TA dose. In 65.4 % of cases, haemoptysis resolved within 48 h with TA use. A home haemoptysis management plan, with guidance for outpatient TA use was provided to 19 adults.

Conclusions: Nebulised TA is a well-tolerated, non-invasive and inexpensive pharmacological option for in- and outpatient management of haemoptysis in CF. Our data support the use of TA to minimise further bleeding in CF outpatients, while waiting for further intervention from their CF service. However, first-dose trials should be supervised to assess for safety and side effects, and a personalised home haemoptysis management plan should be provided prior to use.

Keywords: Cystic fibrosis; Haemoptysis; Medications; Nebulised; Tranexamic acid.