Bleeding treatments

Treatments

1) PRBCs

2) DDAVP (0.3mirog/kq SQ/IV)

3) Platelets

4) FFP

5) Cryopreticipate

6) Vitamin K (10mg SQ/IM)

7) Protamine (Heparin)

8) Estrogen (Renal)

9) PPI/Pepcid/Octreotide (GI)

Warfarin/Vitamin K Def

(inc PT/INR)

-FFP

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

Heparin/Lovenox

(inc PTT)

-Protamie (1mg IV Q100 U of heparin in previous 4hrs)

-Massive bleed --> cryoprecipitate (10 U IV), then FFP (& platelets, aminocaproic acid infusion if nec)

Liver Disease

-Vitamin K

-PPI/pepcid/octreotide (variceal bleed)

-FFP (& platlets if low)

-DDAVP

Renal Disease

-PRBCs (<8 Hb)

-Hemodialysis

-DDAVP

-Conjugated estrogens (unknown mechanism)

-*Cyroprecipitate & platelets (in life-threatening bleed only)

DIC

(see also DIC)

-IVF

-PRBCs

-Vitamin K

-Folate (1mg IV)

If bleeding predominant DIC:

-FFP (2 U at a time)

-Cryoprecipitate (10 bags at a time)

(Heparin is contraversial in thrombosis predominant DIC)

Factor VIII Inhibitor

(PTT does not correct after mixing)

-high dose Factor VII, prothrombin, or recombinant factor VIIa

Lupus Anticoagulant

(rare)

-warfarin or ASA

Source

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