Hemoptysis is life-threatening. For patients not requiring bronchial arterioembolization (BAE), no medical treatment has been approved as a standard of care. Nebulized tranexamic acid (TA) has become an option due to promising results in low volume hemoptysis but has not been yet evaluated in real life practice.

ATHENE study aims to evaluate TA benefit for patients admitted in a respiratory ICU for hemoptysis who did not require immediately BAE.

Methods: We performed a monocentric (HEGP, Paris) retrospective study comparing patients hospitalized for hemoptysis treated or not by TA. Patients with hemoptysis >200cc or requiring BAE in the first 6h were excluded. Patients were matched based on a propensity score using four variables: volume on admission (<100cc vs ?100cc), etiology (bronchiectasis, cancer, cryptogenic and other causes), previous history of hemoptysis, anticoagulant and/or antiaggregant treatment. Effect of TA on the outcome was assessed by condition logistic regression on the matched data. Each exposed patient was matched up to 2 unexposed patients. The primary endpoint was the resolution of hemoptysis at day 3. Analysis is ongoing.

Preliminary results: From 2017 to 2021, 330 cases were screened, 228 patients were included. 75 patients (33%) received TA. Causes of hemoptysis were bronchiectasis (26,4%), cancer (25,1%), cryptogenic (24,2%), other (24,2%). From 2017 to 2019, 13 patients (9,8%) received TA and 19 (14,4%) required BAE. From 2020 to 2021, 62 patients (64,6%) received TA and 10 (10,4%) required BAE.

Conclusion: In an expert center, TA has become a standard of care in the management of hemoptysis despite lack of strong evidence from RCT. Its benefit has yet to be prospectively evaluated