page179
. Peripheral vascular occlusion,
consult product litera-
ture
. Occluded catheters and cannulas, by injection directly
into catheter or cannula
, 5000–25 000 units dissolved
in suitable volume of sodium chloride 0.9% to fill the
catheter or cannula lumen;
leave for 20–60 minutes
then aspirate the lysate; repeat if necessary
Syner-KINASE
c
(Syner-Med) A
Injection
,
powder for reconstitution,
urokinase,
net
price 10 000-unit vial = £35.95;
25 000-unit vial =
£45.95;
100 000-unit vial = £112.95
Note
50 000-unit
vial
and 250 000-unit
vial
also available from
‘special-order’
manufacturers or specialist importing companies,
see p.
988
2.11
Antifibrinolytic drugs and
haemostatics
Fibrin dissolution can be impaired by the administration
of tranexamic acid, which inhibits fibrinolysis. It can be
used to prevent bleeding or to treat bleeding associated
with
excessive
fibrinolysis
(e.g.
in
prostatectomy,
bladder
surgery,
in dental
extraction in patients with
haemophilia,
in conisation of
the cervix,
and in trau-
matic hyphaema)
and in the management
of
menorr-
hagia.
Tranexamic acid may also be used in hereditary
angioedema,
epistaxis,
and in thrombolytic overdose.
Desmopressin (section 6.5.2)
is used in the manage-
ment
of
mild to moderate haemophilia and von Will-
ebrand’s disease. It is also used for fibrinolytic response
testing.
Etamsylate reduces capillary bleeding in the presence
of a normal number of platelets; it does not act by fibrin
stabilisation, but probably by correcting abnormal adhe-
sion.
Etamsylate is less effective than other treatments
in the management of heavy menstrual bleeding and its
use is no longer recommended.
ETAMSYLATE
(Ethamsylate)
Indications
blood loss in menorrhagia
Cautions
exclude structural or histological causes of
menorrhagia,
or fibroids causing distortion of the
uterine cavity,
before initiating treatment
Contra-indications
acute porphyria (see section
9.8.2)
Breast-feeding
present in milk—manufacturer
advises avoid
Side-effects
nausea,
vomiting,
diarrhoea,
fever (dis-
continue treatment), headache,
rashes
Dose
. 500 mg 4 times daily during menstruation
Dicynene
c
(Sanofi-Aventis) A
Tablets
, scored, etamsylate 500 mg, net price 100–tab
pack = £8.44
Excipients
include sulphites
TRANEXAMIC ACID
Indications
see notes above
Cautions
massive haematuria (avoid if risk of ureteric
obstruction); not for use in disseminated intravascular
coagulation;
irregular menstrual bleeding (exclude
structural or histological causes of menorrhagia,
or
fibroids causing distortion of the uterine cavity, before
initiating treatment);
regular liver function tests in
long-term treatment of hereditary angioedema
Contra-indications
thromboembolic disease
Renal impairment
reduce dose—consult product lit-
erature for details
Pregnancy
no evidence of teratogenicity in
animal
studies;
manufacturer advises use only if potential
benefit outweighs risk—crosses the placenta
Breast-feeding
small amount present in milk—anti-
fibrinolytic effect in infant unlikely
Side-effects
nausea,
vomiting,
diarrhoea (reduce
dose);
rarely
disturbances in colour vision (discon-
tinue),
thromboembolic events,
convulsions,
allergic
skin reactions; dizziness and hypotension on rapid
intravenous injection
Dose
. By mouth, local fibrinolysis, 1–1.5 g (
or
15–25 mg/kg)
2–3 times daily
Menorrhagia (initiated when menstruation has
started),
1 g 3 times daily for up to 4 days; max.
4 g
daily
Hereditary angioedema,
1–1.5 g 2–3 times daily
Epistaxis,
1 g 3 times daily for 7 days
.
By slow intravenous injection,
local fibrinolysis,
0.5–
1 g 3 times daily
.
By continuous intravenous infusion, local fibrinolysis,
following initial treatment by intravenous injection,
25–50 mg/kg over 24 hours
Tranexamic acid
(Non-proprietary) A
Tablets
,
tranexamic acid 500 mg,
net price 60-tab
pack = £5.27
Cyklokapron
c
(Meda) A
Tablets
,
f/c,
scored,
tranexamic acid 500 mg,
net
price 60-tab pack = £14.30
Cyklokapron
c
(Pfizer) A
Injection
,
tranexamic acid 100 mg/mL,
net price 5-
mL amp = £1.55
Blood products
DRIED PROTHROMBIN COMPLEX
(Human Prothrombin Complex)
Dried prothrombin complex is prepared from human
plasma by a suitable fractionation technique,
and
contains factor IX, together with variable amounts of
factors II,
VII,
and X
Indications
treatment and peri-operative prophylaxis
of haemorrhage in patients with congenital deficiency
of factors II,
VII, IX,
or X if purified specific coagu-
lation factors not available;
treatment and peri-
operative prophylaxis of haemorrhage in patients with
acquired deficiency of factors II,
VII,
IX,
or X (e.g.
during warfarin treatment—see section 2.8.2)
Cautions
risk of thrombosis; disseminated intravascu-
lar coagulation;
history of myocardial infarction or
coronary heart disease; postoperative use
Contra-indications
angina;
recent myocardial infarc-
tion (except in life-threatening haemorrhage following
overdosage of oral anticoagulants,
and before induc-
tion of fibrinolytic therapy);
history of heparin-
induced thrombocytopenia
BNF 61
2.11 Antifibrinolytic drugs and haemostatics
159
2
Cardiovascular system