Abhishek Gadre

Tranexamic Acid for Hemoptysis: A review

Tranexamic acid (TXA) is an antifibrinolytic agent used to promote hemostasis. TXA is widely used to arrest bleeding in trauma, perioperatively after cardiac surgery, for menorrhagia, and in hemophilia. Less attention has been given to using TXA to lessen hemoptysis, which is the subject of this systematic review. Three small, underpowered randomized controlled trials have examined the efficacy of TXA in hemoptysis. Two of these assessed intravenous TXA, one of which showed significant reduction in the severity and duration of hemoptysis. The third trial examined oral TXA for controlling hemoptysis and failed to show a significant reduction in the amount or duration of hemoptysis. Although inhaled TXA has been described in several case reports and small series, no trial has examined the efficacy of inhaled TXA. The weight of evidence suggests that systemic administration of TXA is safe and does not increase the risk for thrombosis; no adverse effects have been described in the few available reports of inhaled TXA. Overall, TXA is an underrecognized treatment that may have temporizing value in managing patients with nonmassive hemoptysis. In the context that the available literature is sparse, large, well-designed clinical trials are needed to advance understanding of the role of TXA in hemoptysis.

Reversible Platypnea–Orthodeoxia Syndrome from Ventilation–Perfusion Mismatch in Interstitial Lung Disease: A Novel Etiology

Platypnea-orthodeoxia syndrome is most commonly associated with intracardiac shunts (e.g., atrial septal defect) and intrapulmonary shunts (e.g., hepatopulmonary syndrome). We report a case of platypnea–orthodeoxia syndrome secondary to interstitial lung disease associated with the antisynthetase syndrome. The likely mechanism is predominant lower lung parenchymal disease resulting in significant ventilation–perfusion mismatch on sitting up from a supine position.

Connective Tissue Related Interstitial Lung Disease

Purpose of ReviewInterstitial lung disease (ILD) is a common complication of the connective tissue diseases (CTD) and results in significant morbidity and mortality. This review will focus on recent literature pertaining to the epidemiology, clinical presentation, diagnosis, and treatment of CTD-ILD.Recent FindingsSubclinical ILD can be found in the majority of patients with CTD. Clinically significant ILD is most commonly seen in scleroderma followed by polymyositis/dermatomyositis and rheumatoid arthritis, although it can occur in all of the CTDs. Nonspecific interstitial pneumonia is the most common radiographic and histologic pattern, although usual interstitial pneumonia occurs more frequently in rheumatoid arthritis. Pathogenesis is likely related to a combination of autoimmunity/inflammation, disordered fibrogenesis, and vascular injury. Treatment strategies are evolving to target all three of these pathways.SummaryAlthough further research into treatment strategies is needed, the clinician should be aware of the risk factors and clinical presentation of ILD in the various CTDs in order to identify patients who should be screened and/or have modifications in treatment strategies in order to mitigate the morbidity and mortality associated with CTD-ILD.