172 Series of case studies evaluating the effectiveness of the topical application of injectable tranexamic acid 500 – 1000mg (5–10-mls) and crushed tablets 500mg in the management of bleeding malignant wounds

<h3>Background or Introduction</h3> The physical symptoms of malignant wounds may include: malodour, pain, bleeding, exudate, oedema, necrosis, pruritus, and Infection.¹ Bleeding is a significant problem, and is distressing for the patient, family, and carers. There is some evidence for the use of topical tranexamic acid in injectable form to reduce bleeding, but less for crushed tranexamic acid tablets.^{2 3} There had been occurrences in the community setting, where the injectable form of tranexamic acid had become unavailable. Tablets are not included in the formulary for this indication, so are unable to be prescribed. In the inpatient setting, we agreed to use crushed tranexamic acid tablets as an alternative. <h3>Method</h3> Patient data was collated for 6 consecutive cases where topical tranexamic acid, either injectable or crushed tablets, had been used on wounds over a six-month period. The documented impact of bleeding and need for dressing changes was recorded, as well as the impact on patients’ function and quality of life. <h3>Results</h3> Two patients were treated solely on the IPU, three in the community, and one in both settings. All six patients were observed to have reduced or resolved bleeding of their wounds with application of tranexamic acid to wound dressings. There was no difference observed between the tablet or injectable form. In all patients there was reported to be a positive impact regarding frequency of dressing changes, symptoms and/or quality of life. <h3>Conclusion</h3> These cases suggest that Tranexamic acid can be effective as a topical treatment for bleeding malignant wounds, reducing bleeding and the need for repeated dressing changes and contributing to a better quality of life for patients. From our small case series, it appears that crushed tablets were equally effective as injectable tranexamic acid and may be more easily available for community use. A definitive research trial is needed to confirm this. <h3>Reference</h3> Starace, <i>et a</i>l. Management of malignant cutaneous wounds in oncologic patients. <i>Support Care Cancer</i> 2022 ;<b>30</b>(9):7615–7623. Joshua Montroy, <i>et al</i>. The efficacy and safety of topical tranexamic acid: A systematic review and meta-analysis. <i>Transfusion Medicine Reviews</i> 2018;<b>32</b>:165–178. Palliativedrugs.com 2013 topical; tranexamic acid- what do you do? Survey.