Bleeding treatments: Difference between revisions

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==Treatments==
==Treatments==
# PRBCs
#pRBCs
# DDAVP (0.3mirog/kq SQ/IV)
#DDAVP 0.3mg/kg subQ or IV (max 20mg)
# Platelets
#Platelets
# FFP
#FFP
# Cryopreticipate
#Cryopreticipate
# Vitamin K (10mg SQ/IM)
#Vitamin K (10mg SQ/IM)
# Protamine (Heparin)
#Protamine (Heparin)
# Estrogen (Renal)
#Estrogen (Uterine, renal)
# PPI/Pepcid/Octreotide (GI)
#PPI/Pepcid/Octreotide (GI)
 
==Warfarin/Vitamin K Def==
(inc PT/INR)


==Warfarin/Vitamin K Deficiency==
#FFP
#FFP
#Vitamin K (+/- takes 24hrs to affect & 2wk to wear off)
#Vitamin K (+/- takes 24hrs to affect & 2wk to wear off)


==Heparin/Lovenox==
==Heparin/Lovenox==
(inc PTT)
#Protamie (1mg IV Q100 U of heparin in previous 4hrs)
#Protamie (1mg IV Q100 U of heparin in previous 4hrs)
#Massive bleed --> cryoprecipitate (10 U IV), then FFP (& platelets, aminocaproic acid infusion if nec)
#Massive bleed --> cryoprecipitate (10 U IV), then FFP (& platelets, aminocaproic acid infusion if nec)
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#Vitamin K
#Vitamin K
#PPI/pepcid/octreotide (variceal bleed)
#PPI/pepcid/octreotide (variceal bleed)
#FFP (& platlets if low)
#FFP
#Plts
#DDAVP
#DDAVP


==Renal Disease==
==Renal Disease==
#PRBCs (<8 Hb)
#pRBCs (<8 Hb)
#Hemodialysis
#Hemodialysis
#DDAVP
#DDAVP
#Conjugated estrogens (unknown mechanism)
#Conjugated estrogens (unknown mechanism)
#Cyroprecipitate & platelets (in life-threatening bleed only)
#Cyroprecipitate & platelets (in life-threatening bleed only)


==DIC==
==DIC==

Revision as of 09:38, 12 October 2011

Treatments

  1. pRBCs
  2. DDAVP 0.3mg/kg subQ or IV (max 20mg)
  3. Platelets
  4. FFP
  5. Cryopreticipate
  6. Vitamin K (10mg SQ/IM)
  7. Protamine (Heparin)
  8. Estrogen (Uterine, renal)
  9. PPI/Pepcid/Octreotide (GI)

Warfarin/Vitamin K Deficiency

  1. FFP
  2. Vitamin K (+/- takes 24hrs to affect & 2wk to wear off)

Heparin/Lovenox

  1. Protamie (1mg IV Q100 U of heparin in previous 4hrs)
  2. Massive bleed --> cryoprecipitate (10 U IV), then FFP (& platelets, aminocaproic acid infusion if nec)

Liver Disease

  1. Vitamin K
  2. PPI/pepcid/octreotide (variceal bleed)
  3. FFP
  4. Plts
  5. DDAVP

Renal Disease

  1. pRBCs (<8 Hb)
  2. Hemodialysis
  3. DDAVP
  4. Conjugated estrogens (unknown mechanism)
  5. Cyroprecipitate & platelets (in life-threatening bleed only)

DIC

(see also DIC)

  1. IVF
  2. PRBCs
  3. Vitamin K
  4. Folate (1mg IV)


If bleeding predominant DIC:

  1. FFP (2 U at a time)
  2. Cryoprecipitate (10 bags at a time)
  3. (Heparin is contraversial in thrombosis predominant DIC)

Factor VIII Inhibitor

(PTT does not correct after mixing)

  1. high dose Factor VII, prothrombin, or recombinant factor VIIa

Lupus Anticoagulant

(rare)

  1. warfarin or ASA

Source

1/22/06 DONALDSON (adapted from Tintinalli's)