Treatment of Bleeding PDF

L3 Dr. Alaa AL- Sheek Mashhad Treatment of bleeding Vitamin K (Coagulation vitamin) It is a fat-soluble vitamin. Two natural forms exist: vitamins K1 and K2. Vitamin K1 (phylloquinone) is found infood. Vitamin K2 (menaquinone) is found in...

L3 Dr. Alaa AL- Sheek Mashhad Treatment of bleeding Vitamin K (Coagulation vitamin) It is a fat-soluble vitamin. Two natural forms exist: vitamins K1 and K2. Vitamin K1 (phylloquinone) is found infood. Vitamin K2 (menaquinone) is found in human tissues and is synthesized by intestinal bacteria. Vitamins K1 and K2 require bile salts for absorption from the intestinal tract. K1 is available as oral and parenteral forms. Onset of effect is delayed for 6 hours but the effect is completed by 24 hours when treating reduced prothrombin activity caused by excess warfarin or vitamin K deficiency. Intravenous administration of vitamin K1 should be slow, because rapid infusion can produce dyspnea, chest and back pain, and even death. 1  Mechanism of action: Vitamin K is necessary for final stageof synthesis of six factors in the liverby γ- carboxylation of glutamic acid residue (2, 7, 9, and 10 in addition to the anticoagulant protein S, C). Preparations Phytomenadione (K1): Acts within 12 hours The intravenous formulation is used in emergency. 2  Menaquinone (K2) Menadiol sodium phosphate (K3) Water-soluble, and not need bile salt for absorption Preferred in mal-absorption syndrome. It takes 24 h to act so not used in the treatment of warfarin over dosage. It may cause hemolytic anemia so it should be avoided in neonates, especially those with G6PD deficiency 3 Indications: 1-Hemorrhage due to coumarin anticoagulant. 2-Hemorrhagic disease of newborn. 3-Hypoprothrombinaemia: due to malabsorption syndrome 4-Vitamin K deficiency frequently occurs in hospitalized patients in intensive care units because of poor diet, parenteral nutrition, recent surgery, multiple antibiotic therapy,and uremia. Blood transfusion is an option for treating severe hemorrhage. Aminocaproic acid and tranexamic acid: Both agents are synthetic, orally active, excreted in the urine, and inhibit plasminogen activation. Tranexamic acid is 10 times more potent than aminocaproic acid. A potential side effect is intravascular thrombosis. 4 Features Aminocaproic acid Tranexamic acid Chemistry Derivative of lysine synthetic analog of amino acid lysine. Mechanism of Reversible competitive inhibitor to the lysine receptor found on Action plasminogen. So, inhibit its conversion to plasmin and prevent bleeding. Potency Less potent 10 times more potent Administration By mouth Orally or intravenously Uses Treatment of certain bleeding Treatment of bleeding caused by trauma, Caused by bleeding disorders, postpartum hemorrhage, nose liver disease, cancer. bleeding, tooth removal, heavy menstruation Indications: 1-Prevent the hyperplasminaemic bleeding state that results from damage to certain tissue rich in plasmin (after prostatic surgery, tonsillectomy and menorrhagia) 2-Hemophilia 3-Therapy for bleeding from fibrinolytic therapy. 4-Prophylaxis for re-bleeding from intracranialaneurysms. 5 5-Bladder hemorrhage secondary to radiation-and drug-induced cystitis. 6-Angioedema. Adverse effects Include intravascular thrombosis, hypotension, myopathy, abdominal discomfort, diarrhea, and nasal stuffiness. *Contraindication: Patients with DIC or genitourinary bleeding of the upper tract, e.g., kidney and ureters, because of the potential for excessive clotting. Protamine sulfate: It antagonizes the anticoagulanteffects of heparin. Adverse effects: hypersensitivity, dyspnea, flshing, bradycardia, and hypotension when rapidly injected 6  Bleeding due to Idiopathic thrombocytopenic purpura (ITP) 1- Corticosteroids: they act by immune suppressing effect. They used for acute attack as first chioce. 2- Rho (D) immune globulin [Human; Anti-D]. The mechanism of action of anti-D is not fully understood. 3- Immunosuppressants such as Azathioprine Mycophenolate mofetil: 4- Intravenous immunoglobulin (IVIg) Thrombopoietin receptor agonists Romiplostim (and Eltrombopag) 7 Stimulate platelet production in the bone marrow administered by subcutaneous injection. Effective in treating chronic ITP Side effects: headache, joint or muscle pain Dapsone It is an anti-infective sulfone drug used as a second-line treatment for ITP. 8 Rituximab A chimeric monoclonal antibody against the B cell surface antigen CD20, may sometimes be an effective alternative to splenectomy. 9