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.