The Editor,
Indian Journal of Pharmacology,
We read with great interest the article titled “Efficacy and safety of tranexamic acid nebulization (TXA-NEB) to control bleeding of hemoptysis: The TXA-NEB randomized controlled clinical trial.”[1] We congratulate the authors for addressing an important clinical challenge and for conducting a well-designed study. We wish to offer a few scientific observations.
Hemoptysis is a frequently encountered respiratory emergency, ranging from mild hemoptoic sputum – seen in up to 90% of cases – to massive hemoptysis, which carries nearly 50% mortality. Bronchial artery embolization is considered the standard therapeutic modality; however, its availability is restricted by limited access to interventional radiology services in many parts of our country. This underscores the need for alternative, easily deployable therapies that can stabilize patients or serve as a bridge until definitive intervention becomes feasible.
TXA is commonly used intravenously in trauma, massive hemorrhage, and postpartum hemorrhage.[2] Inhaled TXA has recently gained attention as a potential local hemostatic therapy for hemoptysis, though its use remains off-label. Evidence supporting this approach is mostly derived from case series and small studies. Caban et al., in a retrospective bicenter cohort of 189 patients, reported that nebulized TXA was beneficial for low- to moderate-grade hemoptysis in routine clinical settings.[3] An integrative review of 14 studies by Ye et al. also suggested that nebulized TXA is a promising, safe, noninvasive option for non-massive hemoptysis, with rapid bleeding control and reduced need for invasive procedures; however, long-term safety data remain limited.[4]
In light of these considerations, we seek clarification from the authors regarding the formulation used in the present study: Was a dedicated nebulizer-specific TXA preparation utilized or was the standard injectable TXA solution adapted for nebulization?
We once again commend the authors for their valuable contribution and look forward to their response.
Thank you.
Conflicts of interest
There are no conflicts of interest.
Funding Statement
Nil.
References
- 1.Agrawal A, Dhibar DP, Prakash A, Sreedhara BC, Muthu V, Pannu AK. Efficacy and safety of tranexamic acid nebulization to control bleeding of hemoptysis: The TXA-NEB randomized controlled clinical trial. Indian J Pharmacol. 2025;57:392–400. doi: 10.4103/ijp.ijp_824_25. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Franchini M, Mannucci PM. Tranexamic acid for treatment and prophylaxis of bleeding: A review. Intern Emerg Med. 2020;15:513–21. [Google Scholar]
- 3.Caban V, Tronchetti J, Lovato JB, Martinez S, Dutau H, Astoul P. Nebulized tranexamic acid in low- to medium-abundance hemoptysis: A retrospective study of current practices. Arch Bronconeumol. 2025;61:791–3. doi: 10.1016/j.arbres.2025.06.014. doi: 10.1016/j.arbres.2025.06.014. [DOI] [PubMed] [Google Scholar]
- 4.Ye M, Chen M, Wang C, Jiang Z, Luo H, Ren Y. Nebulized tranexamic acid in the management of hemoptysis: An integrative review. Lung. 2025;203:28. doi: 10.1007/s00408-024-00780-5. doi: 10.1007/s00408-024-00780-5. PMID:39841268. [DOI] [PubMed] [Google Scholar]