Purpose: To evaluate and compare the effect of tranexamic acid versus bleomycin as agents for pleurodesis via chest tube drainage in patients with malignant pleural effusion.

Materials and methods: A prospective randomized controlled study in which pleurodesis was
performed using four ampoules of tranexamic acid each was 5ml (100mg/ml) in a total solution of 20 ml and 30 ml normal saline solution or four vials of bleomycin each was 15 mg in a total solution of 60
mg diluted in 100 ml normal saline and were
infused through chest tube. Patients were evaluated clinically and radiologically before and after treatment and monthly intervals with respect to the effectiveness of pleurodesis.

Results: A total number of 52 patients with symptomatic malignant pleural effusion were
enrolled in this study. Forty sex patient were
fulfilled  the  criteria  for  pleurodesis   utilizing  either

tranexamic acid or bleomycin as sclerosing agents
23 patients each. A complete response (no reaccumulation of fluid requiring aspiration) after 6 months of therapy was obtained in 19 patients
(82.6%) in tranexamic acid group and 16 patients (69.5%) with bleomycin. Complications were
reported more in bleomycin groups with only statistical significance between both groups in chest pain and nausea. All side effects were controlled by simple medications. Unsuccessful pleurodesis were treated with palliative repeated aspiration and one empyema case among bleomycin group were
treated with broad spectrum antibiotics and maintained tube drainage until death occurred 4 weeks later.

Conclusion: Tranexamic acid was an effective alternative agent for pleurodesis with low economic cost and little side effectsts