Bleeding treatments

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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)

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

Heparin/Lovenox

(inc PTT)

  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 (& platlets if low)
  4. 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)