Randomised trial of first-line bronchial artery embolisation for non-severe haemoptysis of mild abundance

Abstract

BackgroundWhereas first-line bronchial artery embolisation (BAE) is considered standard of care for the management of severe haemoptysis, it is unknown whether this approach is warranted for non-severe haemoptysis.Research questionTo assess the efficacy on bleeding control and the safety of first-line BAE in non-severe haemoptysis of mild abundance.Study design and methodsThis multicentre, randomised controlled open-label trial enrolled adult patients without major comorbid condition and having mild haemoptysis (onset <72 hours, 100–200 mL estimated bleeding amount), related to a systemic arterial mechanism. Patients were randomly assigned (1:1) to BAE associated with medical therapy or to medical therapy alone.ResultsBleeding recurrence at day 30 after randomisation (primary outcome) occurred in 4 (11.8%) of 34 patients in the BAE strategy and 17 (44.7%) of 38 patients in the medical strategy (difference −33%; 95% CI −13.8% to −52.1%, p=0.002). The 90-day bleeding recurrence-free survival rates were 91.2% (95% CI 75.1% to 97.1%) and 60.2% (95% CI 42.9% to 73.8%), respectively (HR=0.19, 95% CI 0.05 to 0.67, p=0.01). No death occurred during follow-up and no bleeding recurrence needed surgery.Four adverse events (one major with systemic emboli) occurred during hospitalisation, all in the BAE strategy (11.8% vs 0%; difference 11.8%, 95% CI 0.9 to 22.6, p=0.045); all eventually resolved.ConclusionIn non-severe haemoptysis of mild abundance, BAE associated with medical therapy had a superior efficacy for preventing bleeding recurrences at 30 and 90 days, as compared with medical therapy alone. However, it was associated with a higher rate of adverse events.Trial registration numberNCT01278199

Caring for patients with life-threatening hemoptysis

“…4,6 Pharmacotherapeutic considerations include the cautious use of tranexamic acid, an antifibrinolytic agent, which, despite showing promise in hemorrhage control in trauma and postpartum hemorrhage, lacks robust evidence in the context of lifethreatening hemoptysis. [7][8][9] Supportive therapies include blood product transfusion and supplemental oxygen, particularly for less severe cases.…”

Society of Chest Imaging and Interventions Consensus Guidelines for the Interventional Radiology Management of Hemoptysis

“…Life-threatening hemoptysis may be defined as any hemoptysis that is > 150 mL in volume in 24 hours or hemoptysis at a rate of 100 mL/h, and hemoptysis that causes airway obstruction/respiratory failure/hemodynamic instability requiring blood transfusions. 5,[7][8][9] (Level A)…”

“…Bronchoscopy can be used for lateralization of bleeding, clot extraction, direct instillation of medications and cold saline solution for hemorrhage, balloon tamponade, ablation of hemorrhagic arteries, and for selective intubation to maintain airway patency. 2,9 (Level A).…”

Application of the 5F JL4 Catheter in Bronchial Artery Embolization With the Opening in the Inferior Wall of the Aortic Arch

“…Therefore, BAE has become the first choice of treatment for hemoptysis. 6,7 However, the number, opening position, and running direction of the BA varied greatly in each patient, which made it difficult for interventional physicians.…”