Bleeding wounds in palliative care

To manage bleeding wounds in patients with palliative care needs, consider the following:

• If the patient is taking antiplatelet or anticoagulant drugs, consider stopping them—see Principles of medication rationalisation in palliative care.
• Alginate dressings can activate coagulation and help reduce bleeding.
• Locally applied styptics (eg silver nitrate) may be effective at small sites of bleeding.
• Palliative radiotherapy can reduce the size of a malignant wound and help control bleeding.

For rapid control of a bleeding wound that continuously oozes, adrenaline (epinephrine) can initially be used topically to achieve haemostasis until a dressing can be appliedGroenewold, 2011Wilcock A, 2020. Use:

Do not use topical adrenaline for longer than 10 minutes because of the risk of ischaemic necrosis and rebound vasodilation.

It is the consensus of the Palliative Care Expert Group that tranexamic acid may be used topically for ongoing control of a bleeding wound that continuously oozesKer, 2013Montroy, 2018Scottish Palliative Care Guidelines bleeding, 2020Wong, 2016. Crush one tablet and disperse in 10 mL of water, then apply directly to the wound. Alternatively, soak a nonadherent dressing in the solution, place on the wound and apply pressure for 10 minutes, this may be left in situ.

If available, the tranexamic acid solution for injection can also be used topically.

Oral tranexamic acid may be used to control ongoing bleeding; see drug regimens in Persistent bleeding in palliative care.

Some patients with bleeding cancer-associated wounds may be at risk of major bleeding that may be fatal, particularly if the tumour is known to be close to a major artery. For further information on planning for and managing such an event, see Major bleeding in palliative care.