Treatment of bleeding upper aerodigestive tract tumor-a novel approach with antifibrinolytic agent: case series and literature review.

OBJECTIVES/HYPOTHESIS: Symptomatic bleeding among patients with advanced upper aerodigestive tract tumor is a challenging problem. Given the limited options for topical treatment, embolization is often required to control the hemorrhage. There are recent reported cases of novel and successful treatment of patients with recalcitrant tracheo-bronchial bleed with tranexamic acid. We therefore described our initial experience of four consecutive cases of patients with bleeding from advanced aerodigestive tract tumor, successfully treated with oral tranexamic acid.

STUDY DESIGN: Case series.

METHODS: Case series of four consecutive patients with acute bleed from upper aerodigestive tract tumors, treated with oral tranexamic acid. Tranexamic acid was administered topically and systemically (1gm PO QID) for the orophayngeal and supraglottic tumor cases, where as systemic-only therapy were administered to the patients with nasal and nasopharyngeal tumors.

RESULTS: None of the patients experienced further bleeding following the commencement of tranexamic acid treatment, and no adverse effect was noted. These are the first reported cases of symptomatic upper aerodigestive hemorrhage being controlled with tranexamic acid. It is increasingly being used in patients with life-threatening bleeding following trauma and major surgery. The optimum dose of tranexamic acid is undetermined. In vivo studies suggested concentrations of 10 μg/mL to 16 μg/mL for optimal anti-fibrinolytic effect, which is achievable with 1gm QID of oral administration. Large randomized controlled trials assessing the utility of tranexamic acid in various orthopedic surgeries did not show increased thromboembolic events.

CONCLUSIONS: Tranexamic acid should be considered for patients with symptomatic nonarterial bleeding of the upper aerodigestive tract tumors.

LEVEL OF EVIDENCE: 4.