Table 1: Overview of bleed treatment
| Treatment options | Dosing | Contraindications* | Adverse effects* | Monitoring and prevention of side effects |
|---|---|---|---|---|
| FEIBA® | 50-100 U/kg (i.v.) every 6-12 hours, at maximum 200 U/kg daily. | Acute venous or arterial thrombosis. DIC. |
Arterial and venous thrombosis. Gastrointestinal symptoms. Dyspnoea. Coughing. |
Clinical monitoring and ROTEM/TEG (alt. another global hemostatic method) can be used when available. |
| NovoSeven® | 70-90 mg/kg (i.v.) at an initial interval of 2-3 hours until hemostasis is achieved, thereafter increasing the interval (4, 6, 8, 12 hours). An initial dosage of up to 120 mg/kg can be used. | Arterial and venous thrombosis. DIC. Elevation of hepatic enzymes. Headache. Rash. Nausea. |
Clinical monitoring and ROTEM/TEG (alt. another global hemostatic method) can be used when available. | |
| Factor concentrates (human) | 100-200 U FVIII/kg. Alternative dosages: 20 U of factor concentrate for each BU, with an additional 40 U/kg and 90 U/kg every 2-3 hours. (Dosage based on recommendations for AHA) |
(Depends on the factor concentrate). | (Depends on the factor concentrate). | Clinical monitoring and measurement of factor level. Monitoring of APTT (if initially prolonged). Factor levels should be determined at least once daily initially in order to evaluate the continued treatment. A level of 0.30 kIU/L or more should be aimed at. There is, however, no definite correlation between plasma levels and the clinical response, therefore the clinical condition must be carefully evaluated on a daily basis. |
| Porcine FVIII | 50-200 U FVIII/kg as initial treatment. Subsequent dosing dependent on in vitro recovery and presence of anti pFVIII antibodies. | Previous anaphylactic reaction on administration of the product. | Allergic reactions, anti pFVIII antibodies. No thrombosis in 29 patients evaluated. |
Clinical monitoring and measurement of factor level. |
| Tranexamic acid | 10 mg/kg (i.v.) or 20 mg/kg (p.o.) every 6-8 hours. The dosage has to be adjusted if the serum creatinine is >120 mmol/L. | Acute venous or arterial thrombosis. DIC. Haematuria (should not be used if bleeding from the upper urinary tract is suspected). |
Diarrhoea, vomiting, nausea. Allergic dermatitis. Thrombosis, anaphylactic reaction, convulsions (unknown incidence). |
Clinical monitoring. There is a risk for accumulation in patients with kidney failure, please refer to dosing and product resume. |
| Desmopressin | 0.3 µg/kg i.v. or s.c., or 300 µg (nasal spray). The dose may be repeated twice with 12 or 24 h intervals. Tranexamic acid should be administered concomitantly, if not contraindicated. |
SIADH. Unstable angina. Heart insufficiency and other conditions requiring treatment with diuretics. Habitual or psychogenic polydipsia. Von Willebrand disease type 2B. Hyponatraemia. |
Fatigue, temporary hypotensive episode, nausea, headache, dizziness, hyponatremia, thrombosis (unknown incidence). | Clinical monitoring and measurement of FVIII. Treatment increases risk for fluid retention and hyponatremia, and the patient’s fluid intake should be limited. Electrolytes should be monitored throughout treatment duration. |
*The physician should refer to product resume prior to administration for more detailed report, this list is considered incomplete. Concerns all a forementioned formulations: allergic reactions can occur as an adverse event and hypersensitivity to the product or component of the formulation is a contraindication.