Renal disease induced coagulopathy: Difference between revisions
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#Acute dialysis | #Acute dialysis | ||
##pRBCs | ##pRBCs | ||
###Raising | ###Raising HCT to above 25-30% improves bleeding time | ||
##Desmopressin | ##Desmopressin | ||
###Simplest and least toxic acute treatment | ###Simplest and least toxic acute treatment | ||
###Increases release of factor VIII:von Willebrand factor multimers | ###Increases release of factor VIII:von Willebrand factor multimers | ||
###0.3 | ###0.3 mcg/kg IV (preferred) or SC (max 20mg). 3mcg/kg intranasaly is an option. | ||
###Onset of action ~1hr, duration of action ~4-24hr | ###Onset of action ~1hr, duration of action ~4-24hr | ||
#Estrogen | #Estrogen | ||
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#Cryoprecipitate | #Cryoprecipitate | ||
##Only indicated for life-threatening bleeding resistant to DDAVP and blood tranfusion | ##Only indicated for life-threatening bleeding resistant to DDAVP and blood tranfusion | ||
##10 bags over 30 minutes | |||
#Plt transfusion | #Plt transfusion | ||
##Minimally effective b/c infused plts quickly acquire the uremic defect | ##Minimally effective b/c infused plts quickly acquire the uremic defect | ||
##Only use when uncontrolled hemorrhage | |||
#Topical Hemostatic Agents | |||
##Gelatin - Gelfoam or Surgifoam | |||
##Thrombin - Floseal | |||
==See Also== | ==See Also== | ||
Revision as of 22:56, 12 January 2014
Background
- Uremic toxins inhibit platelet aggregation
- Disrupts vWF
- PT/PTT normal, but bleeding time elevated
- Dialysis filter may cause thrombocytopenia
Treatment
- Acute dialysis
- pRBCs
- Raising HCT to above 25-30% improves bleeding time
- Desmopressin
- Simplest and least toxic acute treatment
- Increases release of factor VIII:von Willebrand factor multimers
- 0.3 mcg/kg IV (preferred) or SC (max 20mg). 3mcg/kg intranasaly is an option.
- Onset of action ~1hr, duration of action ~4-24hr
- pRBCs
- Estrogen
- Unclear mechanism of action
- Onset of action within 1d
- Options
- Conjugated estrogen 0.6mg/kg IV or 2.5-25mg PO daily
- Cryoprecipitate
- Only indicated for life-threatening bleeding resistant to DDAVP and blood tranfusion
- 10 bags over 30 minutes
- Plt transfusion
- Minimally effective b/c infused plts quickly acquire the uremic defect
- Only use when uncontrolled hemorrhage
- Topical Hemostatic Agents
- Gelatin - Gelfoam or Surgifoam
- Thrombin - Floseal
See Also
Source
- Tintinalli
- UpToDate