Searching for the ideal pleurodesis agent still continues, Bleomycin is one of the most commonly used agents for pleurodesis. Tranexamic acid have been reported as a cheap pleurodesis agent by many authors. In this study, we evaluate the efficacy, safety and cost of using a combination of bleomycin and Tranexamic acid versus each agent alone.


Sixty three patients with massive malignant pleural effusions were divided in 3 equal groups in a simple randomized manner. Tranexamic acid (30 mg/kg [maximum of 2 g] in 50 mL of normal saline) was administered through a chest tube in Group 1. Group 2 received bleomycin (1 U/kg [maximum of 60 U] in 70 mL of normal saline). Group 3 received the above 2 preparations (tranexamic acid, 30 mg/kg [maximum of 2 g] in 40 mL of normal saline and bleomycin, 1 U/kg [maximum of 60 U] in 50 mL of normal saline) instilled one following the other by 15 minutes. Follow-up CXR examinations were performed at 7 days, 30 days, 60 days and 90 days.


There was no significant difference in the complete response rate of the 3 groups during the first 60 days days. At the end of the study at 90 days, Group 3 had a significantly higher complete response rate (65 %) compared with Groups 1 and 2 (27 % and 35 %, respectively).The rate of complications was nearly equal in the three groups. The most common complications were chest pain, fever and worsening dyspnea.


Using a combination of bleomycin and tranexamic acid for pleurodesis in patients with malignant pleural effusion is more efficient than using each agent alone without significant increase in the cost or complications.