Appendix A

Suggested treatment for minor surgery and procedures in high-risk patients

Clinical situation	Treatment
Minor surgery	Just before start of surgery, rFVIIa is given at 15 µg/kg iv in combination with tranexamic acid 10 mg/kg iv. The rFVIIa dose is repeated after 6 hours. Tranexamic acid is given orally at 20 mg/kg three times daily (ttd.) for 3-7 days.
Regional, spinal and epidural anesthesia as well as diagnostic lumbar puncture	Just before start of the procedure, rFVIIa is given at 15 µg/kg iv, in combination with tranexamic acid 10 mg/kg iv.
Endoscopic procedure without biopsy	No pre-treatment.
Endoscopic procedure with biopsy	Just before start of the procedure, rFVIIa is given at 15 µg/kg iv in combination with tranexamic acid 10 mg/kg iv. Thereafter tranexamic acid is given orally at 20 mg/kg ttd for 3 days.
Implantation of external central venous catheter and subcutaneous venous ports	See “Minor surgery”.
Renal biopsy	See “Minor surgery”.
Minor dental procedures	Local application of tranexamic acid for one hour.
Major dental procedures (extraction of multiple teeth)	Just before start of the procedure, rFVIIa is given at 15 µg/kg iv in combination with tranexamic acid 10 mg/kg iv. Thereafter tranexamic acid is given orally at 20 mg/kg ttd. for 3 days.
Acupuncture	Tranexamic acid is given orally at 20 mg/kg ttd the day of the procedure, starting in the morning.
Bone marrow aspiration	No pre-treatment
Bone marrow biopsy	Just before start of the procedure, rFVIIa is given at 15 µg/kg iv in combination with tranexamic acid 10 mg/kg iv. Thereafter tranexamic acid is given orally at 20 mg/kg ttd for 3 days.
Angiography with puncture of the femoral vein	Just before start of the procedure, rFVIIa is given at 15 µg/kg iv in combination with tranexamic acid 10 mg/kg iv. Thereafter tranexamic acid is given orally at 20 mg/kg ttd for 3 days.
Injection of botox or hyaluronic acid	Just before start of the procedure, rFVIIa is given at 15 µg/kg iv in combination with tranexamic acid 10 mg/kg iv.
Transplantation of dermal grafts	Just before start of the procedure, rFVIIa is given at 15 µg/kg iv in combination with tranexamic acid 10 mg/kg iv. Thereafter tranexamic acid is given orally at 20 mg/kg ttd for 3 days.
Electro Convulsive Treatment (ECT)	Just before start of the procedure, rFVIIa is given at 15 µg/kg iv in combination with tranexamic acid 10 mg/kg iv. Thereafter tranexamic acid is given orally at 20 mg/kg ttd for 3 days.
Heart catheterization	Just before start of the procedure, rFVIIa is given at 15 µg/kg iv in combination with tranexamic acid 10 mg/kg iv.
Dermal excision	Tranexamic acid is given orally at 20 mg/kg ttd for 3 days starting in the morning the day of the procedure.
Cataract surgery	No pre-treatment.
Liver biopsy	See “Minor surgery”.
Pleural tap	Just before start of the procedure, rFVIIa is given at 15 µg/kg iv in combination with tranexamic acid 10 mg/kg iv.
Prostate biopsy	Just before start of the procedure, rFVIIa is given at 15 µg/kg iv in combination with tranexamic acid 10 mg/kg iv. Thereafter tranexamic acid is given orally at 20 mg/kg ttd for 3 days.
Tattoo	Tranexamic acid is given orally at 20 mg/kg ttd for 3 days starting in the morning the day of the procedure.