Subcutaneous Tranexamic Acid at the End of Life in a Patient With Hereditary Hemorrhagic Telangiectasia

Abstract

Hereditary hemorrhagic telangiectasia (HHT) is an autosomal dominant vascular disorder characterized by vascular malformations, which cause frequent bleeding events including epistaxis and gastrointestinal bleeding.1 We describe the management of an 84-year-old woman with HHT who received end-of-life care on a palliative care ward. When the patient was unable to swallow her tranexamic acid tablets, this was converted to a continuous subcutaneous infusion, which was continued for a week until death. She had no significant bleeding events or site reactions. To our knowledge, this case report is the first to describe the palliative management of a patient with HHT at the end of life. This also adds to the current evidence base that subcutaneous tranexamic acid may be a safe and effective alternative to oral administration. Further research is needed to improve understanding of the appropriate patient selection, safety, and efficacy.