Management of Bleeding in Patients with Advanced Cancer

Abstract

Abstract Learning Objectives After completing this course, the reader will be able to: List at least four local hemostatic agents and dressings for controlling localized bleeding in a patient with cancer. List at least four systemic therapies for controlling bleeding in a patient with advanced cancer. Describe a decision-making process related to managing bleeding in an end-of-life cancer patient. Access and take the CME test online and receive 1 hour of AMA PRA category 1 credit at CME.TheOncologist.com Bleeding occurs in up to 10% of patients with advanced cancer. It can present in many different ways. This article provides a qualitative review of treatment options available to manage visible bleeding. Local modalities, such as hemostatic agents and dressings, radiotherapy, endoscopic ligation and coagulation, and transcutaneous arterial embolization, are reviewed in the context of advanced cancer, as are systemic treatments such as vitamin K, vasopressin/desmopressin, octreotide/somatostatin, antifibrinolytic agents (tranexamic acid and aminocaproic acid), and blood products. Considerations at the end of life are described.