Renal disease induced coagulopathy: Difference between revisions
| Line 15: | Line 15: | ||
#*[[pRBCs]] | #*[[pRBCs]] | ||
#**Raising HCT to above 25-30% improves bleeding time | #**Raising HCT to above 25-30% improves bleeding time | ||
#*[[Desmopressin]] | #*[[Desmopressin]] | ||
#**Simplest and least toxic acute treatment | #**Simplest and least toxic acute treatment | ||
#**Increases release of factor VIII:von Willebrand factor multimers | #**Increases release of factor VIII:von Willebrand factor multimers | ||
Revision as of 12:52, 10 June 2015
Background
- Uremic toxins inhibit platelet aggregation
- Disrupts vWF
- PT/PTT normal, but bleeding time elevated
- Dialysis filter may cause thrombocytopenia
Clinical Features
Differential Diagnosis
Coagulopathy
Platelet Related
- Too few
- Nonfunctional
Factor Related
- Acquired (Drug Related)
- Warfarin (Coumadin)
- Unfractionated heparin
- Low molecular weight heparin (i.e. enoxaparin (Lovenox), dalteparin)
- Factor Xa Inhibitors (e.g. rivaroxaban, apixaban, fondaparinux, edoxaban)
- Direct thrombin inhibitors (e.g. dabigatran, argatroban, bivalirudin)
- Illness induced
- Genetic
Diagnosis
Treatment
- Acute dialysis
- pRBCs
- Raising HCT to above 25-30% improves bleeding time
- Desmopressin
- Simplest and least toxic acute treatment
- Increases release of factor VIII:von Willebrand factor multimers
- 0.3 mcg/kg IV (preferred) or SC (max 20mg). 3mcg/kg intranasaly is an option.
- Onset of action ~1hr, duration of action ~4-24hr
- pRBCs
- Estrogen
- Unclear mechanism of action
- Onset of action within 1d
- Options
- Conjugated estrogen 0.6mg/kg IV or 2.5-25mg PO daily
- Cryoprecipitate
- Only indicated for life-threatening bleeding resistant to DDAVP and blood tranfusion
- 10 bags over 30 minutes
- Platelet transfusion
- Minimally effective because infused platelets quickly acquire the uremic defect
- Only use when uncontrolled hemorrhage
- Topical Hemostatic Agents
- Gelatin - Gelfoam or Surgifoam
- Thrombin - Floseal