• Medical management of bleeding
    • General measures
      • Avoid Dilutional anaemia in bleeding patients
      • Avoid hypothermia
      • Avoid acidaemia
    • Desmopressin 0.3μcg/kg
      • Promotes release of VWf from endothelial storage.
      • Increases factor VIII levels
      • Useful in cirrhosis, NSAIDs, uraemia bleeding
      • Can cause water retention
    • FFP 10-15ml/kg
      • Indicated in surgical bleeding with coagulaopathy
      • Reversal of warfarin 5-10ml/kg
    • Cryo
      • Used for bleeding with hypofibrinogenaemia (<0.75)
    • Coagulation factor concentrates
      • Prothrombin complexes
        • II, VII, IX, X
        • Warfarin reversal
        • 30IU/kg
      • VIIa
        • Can compensate for low factor VIII levels at supranormal levels
    • Fibrinogen concentrates
      • Used for bleeding with hypofibrinogenaemia (<0.75)
    • Platelets
      • Keep >50 but may need higher in neuro procedures, trauma etc
    • Cryosupernatant
      • Contains VWf and fibrinogen
    • Anti-fibrinolytic agents
      • Lysine analogue
        • Tranexamic acid
      • Serpins
        • Aprotonin
          • 500,000 U/hr
    • CEACCP
      Link:ceaccp.oxfordjournals.org/content/7/4/116.full.pdf