Bronchoscopic Delivery of Aminocaproic Acid as a Treatment for Pulmonary Bleeding: A Case Series

Objective Bronchoscopy is an essential therapeutic modality in the treatment of pulmonary bleeding. Although numerous endoscopic treatments exist, topical e-aminocaproic acid has not been described in the literature. This study documents the use of this novel treatment for pulmonary bleeding and compares it to available evidence for tranexamic acid , a similar anti-fibrinolytic agent. Design Case-series study. Setting ICU and general inpatient floors of a tertiary medical center. Patients Forty-six patients receiving endobronchial e-aminocaproic acid for the treatment or prevention of pulmonary bleeding. Measurements and main results Of the 46 patients included in the study, 41.6% and 13% presented with non-massive and massive hemoptysis , respectively. In patients with active pulmonary bleeding, endobronchial application of e-aminocaproic acid and accompanying therapies resulted in cessation of bleeding in 94.7% of cases. A total of six patients received e-aminocaproic acid monotherapy ; in three patients with active bleeding, 100% achieved hemostasis after treatment. Of the 36 patients successfully treated for active pulmonary bleeding, 27.8% had recurrent bleeding within 30 days. Thirty-day adverse events were as follows: death (10 patients), deep vein thrombosis (2 patients), renal failure (2 patients), and stroke (2 patients). Conclusions Endobronchial administration of e-aminocaproic acid during bronchoscopy may be a safe and efficacious option in the treatment and prevention of pulmonary bleeding. Further studies are necessary to better define e-aminocaproic acid's safety profile, optimal routes of administration , and comparative effectiveness to tranexamic acid.