Agents for Controlling Blood Loss

Cardiopulmonary bypass, with extracorporeal circulation during cardiac artery bypass graft or heart valve replacement surgery, causes transient hemostatic defects in blood cells and perioperative bleeding. The protease inhibitor aprotinin (Trasylol) inhibits kallikrein (coagulation phase) and plasmin (fibrinolysis) and protects platelets from mechanical injury. The overall effect after infusion is a decrease in bleeding.

Several biological agents are used intravenously to maintain coagulability in the face of factor deficiencies in hemophilia or Von Willebrand's disease patients. Manufacture of these substances involves extraction from human blood or recombinant technology. They include antihemophilic factor (factor VIII) (Alphanate, Bioclate, others) for hemophilia A patients, factor IX concentrate (Bebulin, AlphaNine, Mononine, others) for hemophilia B patients, and factor VIIa (NovoSeven) for hemophilia and Von Willebrand patients. An increase in factor VIII levels by desmopressin (DDAVP, Concentraid, others), an analog of vasopressin, is useful for managing bleeding in hemophilia A and mild Von Willebrand's disease patients. Anti-inhibitor coagulant complex (Autoplex, FEIBA) provides activated vitamin K-dependent clotting factors to return coagulability to the blood in hemophilia patients and other patients with acquired inhibitors to clotting factors.

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