Bleeding management in palliative medicine: subcutaneous tranexamic acid - retrospective chart review

Objectives To investigate the efficacy and safety of subcutaneously (SC) administered tranexamic acid. Methods A retrospective chart review of the use of SC tranexamic acid in a single palliative care centre. We reviewed the use of this approach since it was introduced in our locality 2 years ago. All clinical notes, medication administration records and infusion monitoring documentation were examined to ascertain therapeutic aim, efficacy and tolerability. Results SC tranexamic acid was administered to 22 patients. The most common causes of bleeding were coagulopathy (5), bleeding tumours (9) and thrombocytopaenia (5). The therapeutic aim was either to prevent (6) or treat (16) bleeding and was achieved in 17/22 patients. During this 2-year period, our experience evolved resulting in a greater use of short bolus infusions to achieve more rapid control of bleeding events. Both short and continuous SC infusions were well tolerated with no instances of SC site reactions. One patient developed a suspected arterial thrombus in the last hours of life around the time of converting from oral (PO) to SC tranexamic acid. Conclusions SC administration of tranexamic acid appears to be an effective and well tolerated alternative option for the palliative management of bleeding when the PO and intravenous routes are not available. Further research is needed to clarify tranexamic acid’s safety in palliative populations.