Antifibrinolytic Therapy Reduces Hemoptysis Admissions in Cystic Fibrosis

Treating hemoptysis with antifibrinolytic therapy using an inpatient and outpatient approach reduced hospital admissions in patients with cystic fibrosis (CF), a study found. The findings were published in CHEST.

Researchers identified 21 adult patients with CF from the Boston Children’s Hospital/Brigham and Women’s Hospital CF Center in Boston, Massachusetts, who were prescribed an antifibrinolytic agent. Electronic medical record data for each hemoptysis episode managed with an antifibrinolytic therapy were collected. Additional data collected during a 54-month treatment period included demographics, bleeding and treatment parameters, and baseline CF-related characteristics. The efficacy of the treatment pathway was evaluated based on the hemoptysis admission rate prior to and following enrollment.

A total of 72 distinct hemoptysis episodes were managed with antifibrinolytic agents in the inpatient and outpatient setting. Approximately two-thirds of the 72 treated episodes were considered moderate or massive hemoptysis. There was a 50% reduction in mean annual admissions after pathway enrollment compared with hemoptysis admission rates prior to enrollment (1.23 admissions per year vs 2.44 admissions per year, respectively; P =.0024).

After a median of 2 days of systemic antifibrinolytic management, bleeding ceased. Other than 1 case of peripherally inserted central venous catheter-associated left upper extremity deep venous thrombosis, no other thromboembolic events or side effects occurred.

The lack of data on time-varying confounders, no randomization or blinding to treatment, and the small patient cohort were some of the limitations of the study.

“Confirmation of our findings and determination of the magnitude of benefit will require a prospective, randomized, placebo-controlled study,” the researchers concluded.

Disclosures: Several authors report financial relationships with pharmaceutical companies, including Agios, Boehringer Ingelheim, Bristol-Myers Squibb, Unum Therapeutics, and Portola.

Reference

Al-Samkari H, Shin K, Cardoni L, et al. Antifibrinolytic agents for hemoptysis management in adults with cystic fibrosis [published online February 18, 2019]. CHEST. doi:10.1016/j.chest.2019.02.010