Is thalidomide used to stop bleeding?

Thalidomide is Not Used to Stop Bleeding as a Primary Indication

Thalidomide is not indicated or approved for stopping bleeding as a primary therapeutic purpose. Rather, it is primarily used in the treatment of multiple myeloma and has been associated with an increased risk of thromboembolism that requires prophylactic anticoagulation 1.

Thalidomide's Primary Indications and Mechanisms

Thalidomide works through several mechanisms:

• Immunomodulatory effects
• Inhibition of tumor necrosis factor-alpha (TNF-α)
• Anti-angiogenic properties (inhibits formation of new blood vessels)
• Attacks multiple targets in the myeloma cell microenvironment 1

Its primary approved uses include:

• Treatment of multiple myeloma (often in combination with dexamethasone)
• Treatment of erythema nodosum leprosum

Thromboembolic Risk with Thalidomide

Far from stopping bleeding, thalidomide actually increases the risk of blood clots:

• Thalidomide carries a significant risk of thromboembolism (up to 5% per month of treatment), especially when combined with dexamethasone or chemotherapy 2
• The most common toxicities associated with thalidomide/dexamethasone include venous thromboembolism (15.3% vs. 9.2% compared to lenalidomide/dexamethasone) 1
• Mandatory thromboprophylaxis is recommended for patients receiving thalidomide-containing regimens 1, 2

Thromboprophylaxis Requirements

Due to the increased risk of clotting (not bleeding), patients on thalidomide require:

• Prophylactic anticoagulation with either LMWH (e.g., enoxaparin 40 mg/day) or dose-adjusted warfarin (INR 2-3) for high-risk patients 1
• Aspirin prophylaxis (81-325 mg daily) for patients with one or fewer risk factors 1
• The International Myeloma Working Group recommends thromboprophylaxis based on risk assessment for all patients receiving thalidomide 1

Limited Evidence for Bleeding Control

While there are some small studies suggesting thalidomide might help with specific types of gastrointestinal bleeding:

• A small study (n=6) showed thalidomide might be useful for patients with refractory intestinal bleeding, likely due to its anti-angiogenic properties 3
• Some evidence exists for treatment of bleeding from gastrointestinal angiodysplasias 4, 5

However, these are off-label, investigational uses and not primary indications. The evidence is limited to small studies and case reports, not large randomized controlled trials or guideline recommendations.

Important Considerations and Warnings

• Thalidomide carries a black box warning regarding the risk of venous thromboembolism 1
• It is highly teratogenic and subject to strict REMS (Risk Evaluation and Mitigation Strategy) programs
• Other side effects include peripheral neuropathy, sedation, and constipation 6

In conclusion, thalidomide is not used as an agent to stop bleeding in standard medical practice. On the contrary, patients taking thalidomide typically require anticoagulation to prevent thrombosis, which would be counterproductive if bleeding control were the goal.