Notes

The effects of vitamin K are prolonged so it should be avoided where patients therapy. A dose of 10mg is given orally or by slow intravenous injection daily are dependent on oral anticoagulant . In life threatening haemorrhage

5-10mg is given by slow intravenous injection with other coagulation factor concentrates. If INR >7 or in less severe haemorrhage 0.5-2mg may be given by slow intravenous injection with minimum lasting effect on oral anticoagulant therapy.

Protamine has an anticoagulant effect of its own in high doses. Protamine 1mg neutralises 100IU unfractionated heparin if given within 15min. Less is required if given later since heparin is excreted rapidly. Protamine should be given by slow intravenous injection according to the APTT. Total dose should not exceed 50mg. Protamine injection may cause severe hypotension

Tranexamic acid has an antifibrinolytic effect by antagonising plasminogen. The usual dose is 1-1.5g 6-12-hrly orally or by slow intravenous injection.

Recombinant factor VIIa is licensed for use in haemophilia but a number of case series in major trauma, orthopaedic and cardiac surgery report benefit in severe, intractable bleeding that had not responded to standard measures. The dose is 4500IU/kg over 2-5min, followed by 3000-6000IU/kg depending on the severity of bleeding.

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