Review article: Thalidomide for the management of gastrointestinal bleeding in a palliative care setting.

Palliative care patients frequently present with cinically significant gastrointestinal bleeding. Due to the existence of confounding comorbidities and an often remarkably reduced state of general health, the management of gastrointestinal bleeding in this population is often challenging.This review summarises and discusses the role of thalidomide in gastrointestinal bleeding with a special focus on palliative care patients. In addition, an illustrative case report is presented. Thalidomide may be beneficial in gastrointestinal bleeding by exerting antiangiogenic effects. The drug has an acceptable safety profile. Given its teratogenicity, thalidomide should not be administered to women of childbearing potential who are not using adequate contraception. Other side effects of thalidomide like neurotoxicity may limit its use, but can be monitored safely. Due to thalidomide's thrombin generating potential, patients managed with thalidomide-containing regimes should be closely monitored for deep venous thrombosis.Physicians caring for patients in a palliative care setting should be aware of thalidomide as an effective therapeutic option when endoscopy fails to find a bleeding source or for those patients who cannot or refuse to undergo endoscopy but present with recurrent or obscure gastrointestinal bleeding.