The Efficacy of Tranexamic Acid and Adrenaline to Control Endobronchial Bleeding

During bronchoscopy (a procedure using a thin, flexible camera to look inside the airways), doctors sometimes take small tissue samples (biopsies) to diagnose lung conditions. This can cause bleeding in the airway. Doctors currently use a medicine called adrenaline to stop this bleeding, but it doesn't always work, and bleeding can come back afterward. Another medicine, tranexamic acid, may work better because it helps blood clot and stay clotted, rather than just narrowing the blood vessels. This study compared tranexamic acid and adrenaline, both given directly onto the bleeding site through the bronchoscope, in patients who developed moderate bleeding after a biopsy. The goal was to find out which medicine stopped the bleeding better right away, and which one was less likely to let the bleeding start again within 30 minutes.

Inclusion Criteria: * Adult patients of any age and gender undergoing diagnostic flexible bronchoscopy for suspected benign or malignant airway disease * Required endobronchial forceps biopsy during the procedure * Developed moderate endobronchial bleeding following biopsy (defined as bleeding that obscured the bronchoscopic view, required repeated suctioning to clear the airway, and required endoscopic intervention for hemostasis, but remained hemodynamically stable) Exclusion Criteria: * Severe bleeding (requiring instillation of ice-cold saline, bronchoscopic tamponade, electrocautery, or argon plasma coagulation) * Life-threatening bleeding (requiring endotracheal intubation, or spontaneous hemoptysis of more than 100-150 mL per hour) * Contraindications to bronchoscopy, including: 1. Cardiac arrhythmias 2. Oxygen saturation below 90% on supplemental oxygen 3. Acute respiratory failure with hypercapnia 4. Tracheal obstruction * Bleeding diathesis with raised INR or platelet count less than 50,000/mm³ * Unstable coronary artery disease * Hypersensitivity to tranexamic acid or adrenaline