Tranexamic Acid Inhalation for Severe Hemoptysis in a Patient with Lung Cancer and Deep Venous Thrombosis

背景：咳血是肺癌患者在臨床上常見的症狀，目前對於咳血的治療，經常使用靜脈注射或口服氨甲環酸（tranexamic acid, TA）。然而，全身性注射或口服的TA，有時不適合在有些潛在的禁忌症的情況下，如合併深靜脈血栓之咳血病患。病例報告：我們報告一個嚴重咳血的肺癌病患，且同時合併有深靜脈血栓的情況。病患最初因下肢深靜脈血栓接受低分子量肝素（enoxaparin）皮下注射，獲得控制後，改為口服warfarin治療。然而，經過幾天的抗凝血劑，他發生了大量咳血的情況。我們立即停止口服warfarin，並給予病患靜脈注射TA，但咳血仍持續未有改善。此外，因停止抗凝劑和使用TA後，深靜脈血栓的部分變為更加嚴重，且原本只有下肢深靜脈血栓，進展合併上肢深靜脈血栓。為了同時處理咳血和深靜脈血栓並存的兩難困境，我們使用吸入型TA治療咳血，並使用依諾肝素（enoxaparin）皮下注射治療深靜脈血栓。於使用吸入型TA後，咳血逐漸改善並停止。其深靜脈血栓也時使用依諾肝素治療後逐漸好轉。結論：吸入型TA對於嚴重的咳血是有效的，且深靜脈血栓並非其禁忌症。我們建議，採用這種治療策略於咳血合併深靜脈血栓之患者。

關鍵字

肺癌；氨甲環酸；咳血；深靜脈血栓

並列摘要

Background: Hemoptysis is a common clinical symptom in patients with lung cancer. Intravenous or oral tranexamic acid (TA) is frequently used to treat. However, systemic TA is not appropriate in some cases with potential contraindications such as vascular occlusive events. Case report: We here report a case of lung cancer with severe hemoptysis and deep venous thrombosis (DVT). He initially received low-molecular-weight heparins subcutaneously and shifted to oral warfarin for DVT. However, after few days of anticoagulant, he suffered from severe hemoptysis. Warfarin was discontinued and the patient was prescribed intravenous TA. The hemoptysis still persisted and DVT progressed after TA and discontinuation. In order to manage the dilemma of coexisting hemoptysis and DVT, we provided inhaled TA for hemoptysis and enoxaparin subcutaneously twice daily for DVT. The hemoptysis subsided soon after inhaled TA. His DVT also gradually improved after enoxaparin treatment. Conclusion: Inhaled TA is effective in severe hemoptysis and is not contraindicated in patients with DVT. We suggest utilizing this treatment strategy in patients with both hemoptysis and contraindication for systemic TA.

並列關鍵字

lung cancer ； tranexamic acid ； hemoptysis ； deep venous thrombosis

國際替代計量

Tranexamic Acid Inhalation for Severe Hemoptysis in a Patient with Lung Cancer and Deep Venous Thrombosis

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