Efficacy of tranexamic acid as pleurodesis agent in malignant pleural effusion

Design: A prospective case series. Aim: On a search for an effective, safe, cheap, and available sclerosing agent, the present study aimed to evaluate the effectiveness and the safety of tranexamic acid as a chemical agent for pleurodesis in malignant pleural effusion (MPE). Methods: Tube thoracostomy was done for drainage of pleural fluid. Once the tube in the pleural space drains 150 ml per day or less with fully expanded lung, infusion of pleurodesis solution containing 2000 mg of tranexamic acid [four ampoules of tranexamic acid each is 5 ml (100 mg/ml), mixed with 50 ml of normal saline] was done through the intercostal tube. The tube was then clamped immediately and left in the pleural cavity for 2 h. Follow up chest radiographs were done every 24 h till removal of the tube which was done when daily drainage is 100 ml or less. Chest X ray (CXR) was done after three months to judge success (no fluid re-accumulation). The results were statistically analyzed and tabulated. Results: Sixteen patients with MPE were included in this study, 9 (56%) males and 7 (44%) females with age ranging from 45 to 70 with mean age +/- SD = 57.5 +/- 8.3 years. The follow up after 3 months showed a complete response rate (no fluid re-accumulation on CXR) of 75% (12 \ 16), a partial response rate (asymptomatic fluid re-accumulation on CXR) of 12.5% (2 \ 16) and a no response rate (symptomatic fluid re-accumulation on CXR that required pleural drainage) of 12.5% (2 \ 16). Conclusion: Tranexamic acid was found to be an effective, safe, cheap, and available sclerosing agent for pleurodesis in recurrent malignant pleural effusion. (C) 2015 The Authors. Production and hosting by Elsevier B.V. on behalf of The Egyptian Society of Chest Diseases and Tuberculosis.