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
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...
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| description | 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.
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.
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.
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.
ISRCTN23323895. |
| doi_str_mv | 10.1186/1471-2407-14-143 |
| format | Article |
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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.
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.
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.
ISRCTN23323895.</description><identifier>ISSN: 1471-2407</identifier><identifier>EISSN: 1471-2407</identifier><identifier>DOI: 10.1186/1471-2407-14-143</identifier><identifier>PMID: 24581173</identifier><language>eng</language><publisher>England: BioMed Central</publisher><subject>Acids ; Adult ; Aged ; Aged, 80 and over ; Airway management ; Biopsy ; Biopsy - adverse effects ; Biopsy - methods ; Bronchoscopy - adverse effects ; Bronchoscopy - methods ; Cancer therapies ; Drug dosages ; Epinephrine - administration & dosage ; Female ; Hemorrhage - drug therapy ; Hemorrhage - etiology ; Hemorrhage - prevention & control ; Humans ; Injections, Intralesional ; Lung cancer ; Lung Neoplasms - complications ; Lung Neoplasms - diagnosis ; Lypressin - administration & dosage ; Lypressin - analogs & derivatives ; Male ; Medical treatment ; Middle Aged ; Outcome Assessment (Health Care) ; Prospective Studies ; Studies ; Technical Advance ; Tomography ; Tranexamic Acid - administration & dosage ; Tumors</subject><ispartof>BMC cancer, 2014-03, Vol.14 (1), p.143-143, Article 143</ispartof><rights>2014 Zamani; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited.</rights><rights>Copyright © 2014 Zamani; licensee BioMed Central Ltd. 2014 Zamani; licensee BioMed Central Ltd.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-b484t-9c544f1d78ed3ee6c2723cdb494c8d9d550738e876acb0362bce2dc75916e4693</citedby><cites>FETCH-LOGICAL-b484t-9c544f1d78ed3ee6c2723cdb494c8d9d550738e876acb0362bce2dc75916e4693</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3944730/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3944730/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,864,885,27924,27925,53791,53793</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24581173$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Zamani, Adil</creatorcontrib><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</title><title>BMC cancer</title><addtitle>BMC Cancer</addtitle><description>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.
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.
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.
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.
ISRCTN23323895.</description><subject>Acids</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Airway management</subject><subject>Biopsy</subject><subject>Biopsy - adverse effects</subject><subject>Biopsy - methods</subject><subject>Bronchoscopy - adverse effects</subject><subject>Bronchoscopy - methods</subject><subject>Cancer therapies</subject><subject>Drug dosages</subject><subject>Epinephrine - administration & dosage</subject><subject>Female</subject><subject>Hemorrhage - drug therapy</subject><subject>Hemorrhage - etiology</subject><subject>Hemorrhage - prevention & control</subject><subject>Humans</subject><subject>Injections, Intralesional</subject><subject>Lung cancer</subject><subject>Lung Neoplasms - complications</subject><subject>Lung Neoplasms - diagnosis</subject><subject>Lypressin - administration & dosage</subject><subject>Lypressin - analogs & derivatives</subject><subject>Male</subject><subject>Medical treatment</subject><subject>Middle Aged</subject><subject>Outcome Assessment (Health Care)</subject><subject>Prospective Studies</subject><subject>Studies</subject><subject>Technical Advance</subject><subject>Tomography</subject><subject>Tranexamic Acid - administration & dosage</subject><subject>Tumors</subject><issn>1471-2407</issn><issn>1471-2407</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><recordid>eNp1ks-P1CAUxxujcdfVuydD4sVLFQoU6sFEJ_5KNvGiZ0IfrzOMbanQjuuf5n8nzexOdo0mJMB7Xz48vo-ieMroS8Z0_YoJxcpKUFUykQe_V5yfQvdvrc-KRyntKWVKU_2wOKuE1Iwpfl78fhfDCLuQIEweiB_naOdlCNH2ebNHmH0YSehIjo94ZYcssuAdmQOZIh5wnAleAabkD0jaHtH5cUvcEtdpWPrZTz2SLkTAKZHWhyl5TCuxx5TZifz0845YsvPbHYk-fV9zN6DXOTHFkKa1kHwB2IQkYcyIx8WDzvYJn1zPF8W3D--_bj6Vl18-ft68vSxbocVcNiCF6JhTGh1HrKFSFQfXikaAdo2TkiquUavaQkt5XbWAlQMlG1ajqBt-Ubw5cqelHdABrhb1Zop-sPGXCdabu5nR78w2HAxvhFCcZsDmCMiP_w_gbgbCYNbWmbV1eZUHz5QX12XE8GPBNJvBJ8C-z20JSzJMUllJKbXM0ud_SfdhiWM2aVVlV1hTV1lFjyrI_qaI3akiRs36u_5Vw7PbVpwO3Hwn_gd1RdCM</recordid><startdate>20140301</startdate><enddate>20140301</enddate><creator>Zamani, Adil</creator><general>BioMed Central</general><general>BioMed Central Ltd</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7TO</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>H94</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20140301</creationdate><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</title><author>Zamani, Adil</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b484t-9c544f1d78ed3ee6c2723cdb494c8d9d550738e876acb0362bce2dc75916e4693</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Acids</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Airway management</topic><topic>Biopsy</topic><topic>Biopsy - adverse effects</topic><topic>Biopsy - methods</topic><topic>Bronchoscopy - adverse effects</topic><topic>Bronchoscopy - methods</topic><topic>Cancer therapies</topic><topic>Drug dosages</topic><topic>Epinephrine - administration & dosage</topic><topic>Female</topic><topic>Hemorrhage - drug therapy</topic><topic>Hemorrhage - etiology</topic><topic>Hemorrhage - prevention & control</topic><topic>Humans</topic><topic>Injections, Intralesional</topic><topic>Lung cancer</topic><topic>Lung Neoplasms - complications</topic><topic>Lung Neoplasms - diagnosis</topic><topic>Lypressin - administration & dosage</topic><topic>Lypressin - analogs & derivatives</topic><topic>Male</topic><topic>Medical treatment</topic><topic>Middle Aged</topic><topic>Outcome Assessment (Health Care)</topic><topic>Prospective Studies</topic><topic>Studies</topic><topic>Technical Advance</topic><topic>Tomography</topic><topic>Tranexamic Acid - administration & dosage</topic><topic>Tumors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Zamani, Adil</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Oncogenes and Growth Factors Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Access via ProQuest (Open Access)</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>BMC cancer</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Zamani, Adil</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>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</atitle><jtitle>BMC cancer</jtitle><addtitle>BMC Cancer</addtitle><date>2014-03-01</date><risdate>2014</risdate><volume>14</volume><issue>1</issue><spage>143</spage><epage>143</epage><pages>143-143</pages><artnum>143</artnum><issn>1471-2407</issn><eissn>1471-2407</eissn><abstract>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.
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.
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.
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.
ISRCTN23323895.</abstract><cop>England</cop><pub>BioMed Central</pub><pmid>24581173</pmid><doi>10.1186/1471-2407-14-143</doi><tpages>1</tpages><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; DOAJ Directory of Open Access Journals; SpringerNature Journals; PubMed Central Open Access; Springer Nature OA Free Journals; EZB-FREE-00999 freely available EZB journals; PubMed Central |
| subjects | Acids Adult Aged Aged, 80 and over Airway management Biopsy Biopsy - adverse effects Biopsy - methods Bronchoscopy - adverse effects Bronchoscopy - methods Cancer therapies Drug dosages Epinephrine - administration & dosage Female Hemorrhage - drug therapy Hemorrhage - etiology Hemorrhage - prevention & control Humans Injections, Intralesional Lung cancer Lung Neoplasms - complications Lung Neoplasms - diagnosis Lypressin - administration & dosage Lypressin - analogs & derivatives Male Medical treatment Middle Aged Outcome Assessment (Health Care) Prospective Studies Studies Technical Advance Tomography Tranexamic Acid - administration & dosage Tumors |
| 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 |
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