title: Bronchoscopic intratumoral injection of tranexamic acid to prevent excessive bleeding during multiple forceps biopsies of lesions with a high risk of bleeding: a prospective case series.
abstract: BACKGROUND
  Significant bleeding may occur following endobronchial forceps biopsy or brushing of necrotic or hypervascular tumors in the airways. In some cases, methods such as endobronchial instillation of iced saline lavage and epinephrine may fail to control bleeding. The present study evaluated the efficacy and safety of a new bronchoscopic technique using intratumoral injection of tranexamic acid (IIT) for control of bleeding during forceps biopsy in patients with endobronchial tumors with a high risk of bleeding.
  
  
  METHODS
  The study was a prospective case series carried out in a single center. Bronchoscopic IIT was performed in those patients who had endoscopically visible tumoral lesions with persistent active bleeding following the first attempt at bronchoscopic sampling. Tranexamic acid (TEA) was injected through a 22-gauge Wang cytology needle into the lesion in nominal doses of 250-500 mg. After 2-3 minutes, multiple forceps biopsy specimens were obtained from the lesion.
  
  
  RESULTS
  Of the 57 consecutive patients included in the study, 20 patients (35.1%) underwent bronchoscopic IIT. The first attempt in 18 patients was endobronchial forceps biopsy (EBB), and because of a high risk of bleeding, the first attempt for the remaining two patients, who were on continuous dual antiplatelet therapy (aspirin and clopidogrel), employed endobronchial needle aspiration (EBNA) as a precautionary measure. Following IIT, subsequent specimens were obtained using EBB in all patients. Multiple forceps biopsy specimens (3-10) were obtained from the lesions (8 necrotic and 12 hypervascular) without incurring active bleeding. The following histopathologic diagnoses were made: squamous cell carcinoma (n = 14), adenocarcinoma (n = 2), small-cell lung cancer (n = 3), and malignant mesenchymal tumor (n = 1). No side effects of TEA were observed.
  
  
  CONCLUSIONS
  Bronchoscopic IIT is a useful and safe technique for controlling significant bleeding from a forceps biopsy procedure and can be considered as a pre-biopsy injection for lesions with a high risk of bleeding.
  
  
  BACKGROUND
  ISRCTN23323895.
authors.affiliation: Department of Pulmonary Medicine, Meram Medical Faculty, Necmettin Erbakan University, Akyokus Mevkii, Meram 42080, Konya, Turkey. adzamani@hotmail.com.
authors.forename: Adil
authors.initials: A
authors.lastname: Zamani
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy / Q000009:adverse effects* / Q000379:methods; D001999:Bronchoscopy / Q000009:adverse effects* / Q000379:methods; D004837:Epinephrine / Q000008:administration & dosage; D005260:Female; D006470:Hemorrhage / Q000188:drug therapy* / Q000209:etiology* / Q000517:prevention & control; D006801:Humans; D015552:Injections, Intralesional; D008175:Lung Neoplasms / Q000150:complications* / Q000175:diagnosis*; D008236:Lypressin / Q000008:administration & dosage / Q000031:analogs & derivatives; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D000077585:Terlipressin; D014148:Tranexamic Acid / Q000008:administration & dosage*
chemical_list: D008236:Lypressin; D014148:Tranexamic Acid; D000077585:Terlipressin; D004837:Epinephrine