Hemostatic Agents

Comments

Dose (IV)

Frequency

FDA approved use

Hemophilia A or B with inhibitors

rVIIa is first-line therapy

90 mcg/kg

Every 2–3 h initially, with subsequent dosing per hematology service

Congenital FVII deficiency

rVIIa is first-line therapy

15–30 mcg/kg

Every 2–3 h initially, with subsequent dosing per hematology service

BIDMC approved use

Acquired inhibitors to FVIII, IX (V, VII, X, XI)

Use in the setting of life- or limb-threatening bleeding

90 mcg/kg

Subsequent dosing to be determined in consultation with the hematology and transfusion medicine services

Glanzmann’s thrombasthenia

In the presence of platelet transfusion refractoriness with documented antibodies to GPIIb-IIIa

90 mcg/kg

Subsequent dosing to be determined in consultation with the hematology and transfusion medicine services

Life-threatening hemorrhage

Continued hemorrhage despite adequate blood product replacement, reversal agents, surgical hemostasis, and other procoagulant therapies

40 mcg/kg

Subsequent dosing to be determined in consultation with the hematology and transfusion medicine services

WARNING: patients with known thromboembolic or vaso-occlusive disease, disseminated intravascular coagulation (DIC), crush injury, advanced atherosclerotic disease, septicemia, or concomitant treatment with prothrombin complex concentrates may have an increased risk of developing thrombotic events

NOTE: all requests for rVIIa must be approved by the Transfusion Medicine Service (pager: 30003)

Approved by: Pharmacy & Therapeutics Committee: 06/13/07

Desmopressin (DDAVP) is a synthetic analog of vasopressin and is used to reduce bleeding in patients with hemophilia and von Willebrand’s disease (although it must be used with caution in subtype 2B as it can induce thrombocytopenia). It is also used to reduce bleeding time in patients who are taking antiplatelet medications such as aspirin and clopidogrel. DDAVP stimulates the release of von Willebrand factor as well as Factor VIII from the endothelium. In the kidney, DDAVP binds to V2 receptors and increases free water absorption, which is the basis for its use in patients with central diabetes insipidus. Of note, DDAVP has no activity at V1 receptors and thus does not promote vasoconstriction. It can be administered orally, intranasally, or intravenously. The intravenous dose of DDAVP to reverse platelet dysfunction from aspirin or clopidogrel is 0.3 mcg/kg over 30 min.

Only gold members can continue reading. Log In or Register to continue