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Abstract
Introduction Patients with life-limiting illnesses are at increased risk of mucosal bleeding. Usual management includes anticipatory planning and sedation, alongside anti-fibrinolytics, despite a lack of evidence for their use. Anti-fibrinolytic agents (tranexamic acid and aminocaproic acid) produce effective haemostasis in different clinical settings. Our aim was to synthesise the evidence for anti-fibrinolytic medication use in adult patients with life-limiting illnesses at risk of, or experiencing, mucosal bleeding.
Methods We searched MEDLINE, Embase, CINAHL, Web of Science Conference Proceedings Citation Index, Cochrane Library databases and clinical trial registries (inception to January 2024) to identify studies investigating the use of anti-fibrinolytics in patients with life-limiting illnesses. Results were screened against a priori inclusion criteria, data ere extracted, and quality was appraised using a CASP (Critical Appraisal Skills Programme) checklist or BMJ risk of bias assessment. Data were analysed using narrative synthesis.
Results Five studies meeting our search criteria (one cohort and four case series) were included. Data relating from 87 patients were used in narrative synthesis. Anti-fibrinolytic therapy was used for active mucosal bleeding in 37 patients, of whom 30 achieved total bleeding cessation. Fifty patients received prophylactic anti-fibrinolytics, of whom 32 experienced no bleeding events. Adverse events were reported in 3 of 87 patients (arterial thrombus, severe thrombocytopenia and stomach cramps). Mortality and quality of life were not reported.
Conclusion Anti-fibrinolytics are generally well tolerated within this population and may prevent and reduce mucosal bleeding. Further high-quality research is suggested to investigate current practice and to compare anti-fibrinolytic with placebo in the management of bleeding in patients with life-limiting illnesses.
PROSPERO registration number CRD42022325529.
- Palliative Care
- Symptoms and symptom management
- Drug administration
Data availability statement
All data relevant to the study are included in the article or within the supplemental material.
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Data availability statement
All data relevant to the study are included in the article or within the supplemental material.
Footnotes
Contributors E Holdsworth, SL, AP and AG were responsible for study design. E Holdsworth, E Hooson, SL, AP and AG designed the search strategies alongside The University of Hull library. E Holdsworth, FH and E Hooson executed the search strategy. All authors were involved in screening abstracts, extracting data and assessing evidence quality. SL, E Holdsworth, AP and E Hooson analysed and synthesised the data. All authors contributed to the write up of the manuscript and all approved the final version for submission. All authors would like to recognise the North, East and West Yorkshire Palliative medicine training scheme for time and support. E Hooson is responsible for the overall content as the guarantor.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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