- Section 1 ICU organization and management
- Section 2 Pharmacotherapeutics
- Part 2.1 Respiratory drugs
- Part 2.2 Cardiovascular drugs
- Part 2.3 Gastrointestinal drugs
- Part 2.4 Nervous system drugs
- Part 2.5 Hormonal drugs
- Part 2.6 Haematological drugs
- Chapter 51 Anticoagulants and antithrombotics in critical illness
- Chapter 52 Haemostatic agents in critical illness
- Part 2.7 Antimicrobial and immunological drugs
- Part 2.8 Fluids and diuretics
- Section 3 Resuscitation
- Section 4 The respiratory system
- Section 5 The cardiovascular system
- Section 6 The gastrointestinal system
- Section 7 Nutrition
- Section 8 The renal system
- Section 9 The neurological system
- Section 10 The metabolic and endocrine systems
- Section 11 The haematological system
- Section 12 The skin and connective tissue
- Section 13 Infection
- Section 14 Inflammation
- Section 15 Poisoning
- Section 16 Trauma
- Section 17 Physical disorders
- Section 18 Pain and sedation
- Section 19 General surgical and obstetric intensive care
- Section 20 Specialized intensive care
- Section 21 Recovery from critical illness
- Section 22 End-of-life care
(p. 229) Haemostatic agents in critical illness
- Chapter:
- (p. 229) Haemostatic agents in critical illness
- Author(s):
Beverley J. Hunt
- DOI:
- 10.1093/med/9780199600830.003.0052
Antifibrinolytics can prevent excessive bleeding during surgery and are also used to reduce established bleeding. By blocking the effects of plasmin, they prevent premature clot breakdown and enhance clot stability. The CRASH-2 trial showed that use of tranexamic acid in those with or at high risk of traumatic haemorrhage reduced mortality by 9%. Importantly for a drug that affects haemostasis, there appears to be no increased risk of either arterial or venous thromboembolism. Aprotinin while an excellent agent in reducing bleeding disproves previous assumption that reducing bleeding improves outcome, for the BART study demonstrated an increased mortality compared with tranexamic acid and EACA. It is still used occasionally in very high risk cardiac surgery patients. DDAVP (desmopressin) stimulates platelet function and is of use in patients with uraemia, although needs to be given with an antifibrinolytics, because it does also stimulate fibrinolytic activity. Off-license use of rVIIa is waning, clinical trials have as yet failed to show major benefit. Moreover, there is a high rate of arterial thrombosis after using rVIIA.
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- Section 1 ICU organization and management
- Section 2 Pharmacotherapeutics
- Part 2.1 Respiratory drugs
- Part 2.2 Cardiovascular drugs
- Part 2.3 Gastrointestinal drugs
- Part 2.4 Nervous system drugs
- Part 2.5 Hormonal drugs
- Part 2.6 Haematological drugs
- Chapter 51 Anticoagulants and antithrombotics in critical illness
- Chapter 52 Haemostatic agents in critical illness
- Part 2.7 Antimicrobial and immunological drugs
- Part 2.8 Fluids and diuretics
- Section 3 Resuscitation
- Section 4 The respiratory system
- Section 5 The cardiovascular system
- Section 6 The gastrointestinal system
- Section 7 Nutrition
- Section 8 The renal system
- Section 9 The neurological system
- Section 10 The metabolic and endocrine systems
- Section 11 The haematological system
- Section 12 The skin and connective tissue
- Section 13 Infection
- Section 14 Inflammation
- Section 15 Poisoning
- Section 16 Trauma
- Section 17 Physical disorders
- Section 18 Pain and sedation
- Section 19 General surgical and obstetric intensive care
- Section 20 Specialized intensive care
- Section 21 Recovery from critical illness
- Section 22 End-of-life care