What is the key question?

• Is tranexamic acid (TXA) effective and safe in controlling iatrogenic bleeding during flexible bronchoscopy (FB) compared with adrenaline?

What is the bottom line?

• The most commonly used topical hemostatic agents during FB are cold saline and adrenaline. Data on use of other agents such as TXA for this purpose are limited.
• This is a cluster-randomized, double-blind, single-center trial in a tertiary teaching hospital, where patients were randomized in weekly clusters to receive up to 3 applications of TXA (100 mg, 2 mL) or adrenaline (0.2 mg, 2 mL, 1:10,000) after hemostasis failure after 3 applications of cold saline (4 degrees Celsius, 5 mL). Crossover was allowed (for up to 3 further applications) before proceeding with other interventions. Bleeding severity was graded by the bronchoscopist using a visual analog scale (VAS; 1=very mild, 10=severe).
• A total of 130 patients were randomized successfully to adrenaline (n=65) or TXA (n=65). Bleeding was stopped in 83.1% of patients in both groups (P=1.0).
• The severity of bleeding and number of applications needed for bleeding control were similar in both groups.
• Both adrenaline and TXA were more successful in controlling moderate bleeding (86.7% and 88.7%, respectively) than severe bleeding (40% and 58.3%, respectively; P=0.008 and P=0.012, respectively) and required more applications for severe bleeding (3.0 ± 0 and 2.4 ± 0.5, respectively) than moderate bleeding (1.7 ± 0.8 and 1.7 ± 0.8, respectively) control (P=0.006 and P=0.002, respectively).
• There were no drug-related adverse events observed in either group.

Why read on?

• This study shows no significant difference between adrenaline and TXA for controlling noncatastrophic iatrogenic endobronchial bleeding after cold saline failure, adding to the body of evidence that TXA can be used safely and effectively during FB.