Background Bleeding at the end of life is distressing. The use of enteral and intravenous tranexamic acid (TA) to manage bleeding is established. The delivery of TA via continuous subcutaneous infusion (CSCI) is an off-label administration of a licenced drug, with limited published data on this use.1 We describe two cases in which the oral route was not reliable, topical agents were not indicated, and we were unable to give platelet transfusions.
Method Two patients received TA via a CSCI: doses were based on IV guidelines for weight and renal function (Palliative Care Formulary). TA was administered in a T34 McKinley syringe driver, made up to 21 mL with water for injection but no other medications.
The first patient with acute myeloid leukaemia had been platelet-dependent until he became unable to attend for transfusions. He was commenced on oral TA at home when he developed epistaxis and intra-oral bleeding. He was admitted to our hospice and was not able to take tablets. He was started on a syringe driver with 1 g TA/24 h. He died within 72 h of admission – bleeding was controlled for this period.
The second patient had bone marrow failure secondary to metastatic prostate cancer. He was commenced on oral TA 1g TDS for haematuria and intra-oral bleeding with good effect. When his oral route became unreliable, a CSCI with 2 g TA/24 h was commenced. No oral bleeding was seen, and haematuria improved, until he died 3 days later.
Conclusions TA given via a CSCI achieved haemostasis. No side-effects or problems at the infusion site were observed. Clot-retention was not seen in the catheterised patient. Based on oral bioavailability (30–50%) and doses used here, the oral to subcutaneous dose conversion may be 2:1. More data is needed to build evidence for this practice.
Sutherland A, Carey M, Miller M. Subcutaneous tranexamic acid: a novel approach to managing bleeding. Ann Hematol Oncol 2021;8(7):1356.
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