Bleeding Solutions in Lung

Hemoptysis is not an uncommon symptom in patients with underlying broncho-pulmonary malignancy, and occurs in about 30% of patients (Hirshberg et al. 1997) and in 10% it can be massive and in 3% fatal (Park et al. 2007). Without treatment, severe hemoptysis is associated with a mortality rate exceeding 50% (Witt et al. 2000). Bleeding can be related to local tumor invasion, tumor angiogenesis, systemic effects of the cancer like thrombocytopenia and coagulopathy, chemotherapy, or iatrogenic related to percutaneous or endoscopic interventions. Existing bleeds can be exacerbated by medications such as bevacizumab, anticoagulants, antiplatelets, and non-steroidal anti-inflammatory drugs. Patients may present with small volume bleeding, episodic major bleeding, or with acute catastrophic bleeding resulting in hemorrhagic shock or severe respiratory distress/failure and ultimately death. Given the complex patient population, multifactorial etiologies, and the variety of treatment modalities involved, palliative management of broncho-pulmonary bleeding has been challenging. Surgery is the definitive treatment for hemoptysis, but the underlying frailty makes these patients unsuitable for any aggressive cardiothoracic surgical interventions. Hence, percutaneous and/or endovascular management is frequently considered a first-line palliative option in these medically precarious patients. Some of the other treatment options include external beam radiotherapy, airway stenting, and endobronchial laser ablation.