Tranexamic Acid in the Management of Hemoptysis: Pharmacology, Administration Routes, Clinical Evidence, and Practical Considerations

Hemoptysis is a frequent and potentially life-threatening pulmonary presentation that requires rapid stabilization and timely definitive management. Tranexamic acid (TXA), a synthetic antifibrinolytic agent, has gained increasing interest as an adjunctive medical therapy for hemoptysis, supported by recent randomized trials, observational studies, and systematic reviews evaluating inhalational and endobronchial routes. While bronchoscopy, bronchial artery embolization (BAE), and surgery remain central to the management of severe or life-threatening hemoptysis, TXA may reduce bleeding burden, shorten hospitalization, and serve as a temporizing or bridging therapy while definitive interventions are arranged. This narrative review summarizes TXA pharmacology, available routes of administration, dosing strategies, clinical evidence, safety considerations, and practical integration into contemporary hemoptysis management pathways. The literature selection approach is briefly described in the manuscript body to improve transparency regarding how representative studies were identified and prioritized.