Tranexamic acid treatment of hemothorax in two patients with malignant mesothelioma

Our plain-English summary of Tranexamic acid treatment of hemothorax in two patients with malignant mesothelioma, by W.A. De Boer, M.G. Koolen, C.M. Roos, et al (Chest, 1991).

The study

• Authors: W.A. De Boer, M.G. Koolen, C.M. Roos, J.W. Ten Cate
• Journal: Chest
• Published: 1991;100(3):847-8
• Type of article: Case report
• Cited by: 21 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Patients with malignant mesothelioma may present with hemothorax. We used a combination of oral and intrapleural tranexamic acid to treat two patients with this severe complication. Initiation of treatment with this potent anti-fibrinolytic drug resulted in rapid reduction of bleeding and of transfusion requirements.

In plain English

This case report described two patients at the Academic Medical Center in Amsterdam whose malignant mesothelioma caused heavy bleeding into the chest cavity (hemothorax) that required repeated blood transfusions. The article states that neither patient had asbestos exposure. Both received tranexamic acid, a drug that slows the breakdown of blood clots, by mouth and also as a 5 g dose once daily for 2 days through the chest drain. In the first patient, a 56-year-old man whose bleeding had continued despite a week of palliative radiotherapy, bleeding stopped within 24 hours. It returned after the drug was stopped, was controlled again, and was lastingly controlled only on maintenance tablets. In the second patient, a 66-year-old woman, drain output fell from 1,000 ml to 50 ml within 3 days. Later, tumor growth caused complications that led to her death. The authors reported no side effects. Noting that their observations were limited to two patients, they suggested the combined treatment is a simple method for decreasing morbidity due to hemothorax in malignant mesothelioma.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Case report (two patients)
• Who was studied: Two patients treated at the Academic Medical Center, Amsterdam. Case 1 was a 56-year-old man with mesothelioma and persistent bleeding into the pleural space, who presented in October 1980. Case 2 was a 66-year-old woman with malignant pleural mesothelioma, who had symptoms from August 1989 and was transferred in December 1989.
• Exposure: The study looked at treatment, not asbestos exposure. Both patients received tranexamic acid by mouth plus a single daily 5 g dose into the pleural space through the chest drain for 2 days. The first patient was later kept on a maintenance dose of 500 mg four times per day. The article reports that neither patient had asbestos exposure.
• Main results:
  • Case 1: palliative radiotherapy given three times daily for 1 week did not stop the bleeding.
  • Case 1: after tranexamic acid was started, bleeding stopped within 24 hours.
  • Case 1: ten days after oral treatment was stopped, a less severe bleeding episode occurred and was again controlled with tranexamic acid.
  • Case 1: lasting control of bleeding came only with maintenance therapy of 500 mg tranexamic acid four times per day.
  • Case 2: chest drain output fell from 1,000 ml to 50 ml within 3 days of starting tranexamic acid.
  • Case 2: after about 2 weeks of good response, tumor growth caused complications that ultimately led to the patient's death.
  • Neither patient had side effects from the combined oral and intrapleural treatment.
  • Neither patient is described as having had asbestos exposure.
• The authors' conclusion: The authors suggested that combined oral and intrapleural tranexamic acid is a simple method for decreasing morbidity due to hemothorax in patients with malignant mesothelioma.
• Limitations the authors state:
  • The observations are limited to only two patients.
  • It is not known whether the combined routes were needed; either route alone might have been sufficient.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma.

Medical terms in this study, explained in our Lexicon: Hemothorax, Malignant Mesothelioma.

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