Pro-Hemostatic Therapies

Question 1

Recombinant activated Factor VIIa (NovoSeven RT)

Route

Indications

Answer 1

Route: IV

Indications: bleeding and perioperative management of congenital factor VII deficiency
acquired hemophilia
congenital hemophilia

massively bleeding trauma pts (improve survivability)

Off label: warfarin related intercerebal hemorrhage

Question 2

Recombinant activated Factor VIIa (NovoSeven RT) MOA

Answer 2

Recombinant factor VIIa, vit K-dependent glycoprotein, promotes hemostasis by activating extrinsic

Question 3

Recombinant activated Factor VIIa (NovoSeven RT)

Adverse effects

Contraindications

Answer 3

BBW- arterial and venous thrombosis
HTN, bradycardia, CVD, fever, vomiting, renal impairment, hypersensistivity rxn, hemorrhage, hemarthrosis

Contraind: NONE

Question 4

What should pt be screened for before and after use of Recombinant activated Factor VIIa (NovoSeven RT)?

Answer 4

PT and factor VII coag activity

Question 5

Transexamic acid (Lysteda)
route
indications

Answer 5

route: IV, PO

indications: heavy menstrual bleeding, tooth extraction in hemophilia
blood loss prevention and reduction in high blood loss surgeries, trauma-associated hemorrhage, traumatic hypehma

Question 6

Transexamic acid (Lysteda) MOA

Answer 6

forms reversible complex that displaces plasminogen from fibrin resulting in inhibition of fibrinolysis and also inhibits proteolytic activity of plasmin

Question 7

Transexamic acid (Lysteda)
Adverse Effects
Contraind

Answer 7

Adverse Effects: HA, abdominal pain, skeletal muscle pain, nasal sx, fatigue, anemia, CNS depression, retinal venous and arterial occlusions, VTE, eizures

Contraind: hypersensitivity, acquired defective color vision, active intravascular clotting, subarachnoid hemorrhage

Question 8

When should Transexamic acid (Lysteda) be used in surgery setting to be mot effective for uncontrolled bleeding?

Answer 8

within 3 hours of injury onset

Question 9

Demopressin (DDAVP)
Route
Indications

Answer 9

Route: IV, intranasal

Indications: diabetes insipidus, nocturia, primary nostural enuresis, hemophilia A, von willebran disease, uremic bleeding, prevention of surgical bleeding in pts with uremia
Off-label: intracranial hemorrhage associated with antiplatelet agents (ASA, Plavix)

Question 10

Demopressin (DDAVP) MOA

Answer 10

Synthetic analogue of ADH arginine vasopressin. IN dose dependent manner, demopressin increases cAMP in renal rubular cells which ↑ water permeability resulting in ↓ urine volume and ↑ urine osmolality

↑ plama levels of vWF, factor VII and t-PA contributing to shortened activate d aPTT and bleeding time

Question 11

Demopressin (DDAVP)
Adverse reactions
Contraind

Answer 11

Adverse reactions: hyponatremia, HA, dizziness, N/V, abdominal pain, rhinitis, nasal congestion, epistaxis, thrombotic events (rare)

Contraind: hypersensitivity to agent, hyponatremia

Question 12

What pregnancy category is Demopressin (DDAVP)?

Answer 12

Cat B