Tranexamic acid in bleeding management of advanced cancer in palliative care: A systematic review

<h2>ABSTRACT</h2><h3>Problem Considered</h3> Bleeding complications in advanced cancer patients under palliative care poses a significant clinical challenge. Tranexamic acid (TXA), has been explored as a potential therapeutic option to control bleeding. This review aimed to summarize the evidence of TXA, with a primary focus on the efficacy and safety profile of TXA in addressing bleeding issues in advanced cancer patients within the palliative care. <h3>Methods</h3> A systematic literature search using relevant keywords was conducted in medical databases, including PubMed, EBSCO, Google Scholar and Cochrane Central Library, from inception until September 14^th, 2023. Randomized controlled trials (RCT), observational studies, and case series or case reports, that evaluated the use of TXA in advanced cancer patients for bleeding management in palliative care settings were included. <h3>Results</h3> A total of eleven studies were included, comprising one observational study, one non-randomized study, six case reports, and three case series. Among the advanced cancer patients, the majority (87%) had solid tumours. Overall success rate for halting bleeding was 91.3%, with a median of 3 days (ranging 15 minutes to 30 days) to achieve complete bleeding cessation. All routes of TXA administration with varying dosages were documented, including subcutaneous (46.5%), oral (23.3%), intravenous (18.6%), and topical (11.6%). Thromboembolic events were observed in 4.3% of the patients. No RCTs were identified during our search. <h3>Conclusion</h3> Tranexamic acid appears to be an effective and well-tolerated option for managing bleeding in advanced cancer patients receiving palliative care. Further research is needed to establish optimal dosing regimens and confirm its safety.