Systemic antifibrinolytic therapy in adult patients with cystic fibrosis (CF), which uses a combined outpatient and inpatient approach, has been associated with a reduced rate of hospital admissions for hemoptysis, according to a study published in CHEST.
Recognizing that hemoptysis is a major cause of morbidity and mortality in patients with CF, and that antifibrinolytic agents have shown efficacy in a wide range of bleeding disorders, investigators sought to explore the use of this therapy for the management of CF in adults. They created a clinical treatment pathway for both inpatient and outpatient use, reporting on rates of hospitalization for bleeding both before and after implementation of this pathway.
All adults with CF who had undergone treatment with systemic antifibrinolytic therapy during a 54-month period based on the treatment pathway were evaluated. Data were obtained with respect to demographics, baseline CF-associated characteristics, and bleeding and treatment parameters. Efficacy of the clinical treatment pathway was assessed by comparing annual hemoptysis hospital admission rates prior to and following pathway enrollment.
Overall, 72 distinct episodes of antifibrinolytic-treated hemoptysis were assessed in a total of 21 adult patients with CF. Of the treated hemoptysis episodes, two-thirds involved moderate or massive hemoptysis. Bleeding stopped after a median of 2 days. Moreover, outpatient treatment was associated with a significant 50% reduction in annual hemoptysis-related hospital admissions following pathway enrollment (2.44 vs 1.23 hospital admissions per year; P =.0024).
The use of antifibrinolytic therapy was well tolerated. There was 1 report of a central venous catheter-associated upper extremity deep vein thrombosis in a patient who experienced a prior thrombosis in the same vein.
The investigators concluded that additional studies are warranted to further elucidate the benefits of systemic antifibrinolytic therapy in patients with CF. Confirmation of the findings from this study as well as the level of benefit will require a prospective, randomized placebo-controlled study.
Disclosures: Several authors report financial relationships with pharmaceutical companies including Boehringer Ingelheim, Bristol-Myers Squibb, Unum Therapeutics, and Portola.
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