Pediatric emergency medicine trisk 2188 2188

reversal of vitamin
K antagonist

deficiency and target
level
Dose for reversal
depends on specific
product and predose
INR

DDAVP
Type I VWD or mild IV formulation—0.3
• Causes release of
(desmopressin)
hemophilia A (if
mcg/kg in 50-mL
VWF and FVIII
patients known to
NS by IV infusion
from endothelial
respond)
over 30 min (max
cells
dose 20 mcg)
• Can exacerbate the
Nasal spray
thrombocytopenia
formulation Stimate
seen with type 2B
(desmopressin
VWD

acetate) 1.5 mg/mL • Side effects: facial
—metered dose
flushing,
pump delivers 0.1
headache, and,
mL (150 mcg) per
rarely,
actuation for
hypertension,
patients ≥50 kg—2
hypotension, and
sprays (1/nostril);
water retention,
<50 kg—1 spray
hyponatremic
seizures have
occurred
Aminocaproic
acid (Amicar)

Mucocutaneous
bleeding

Aminocaproic acid
• Contraindicated in
(pediatric): 50–100
DIC. Avoid use
mg/kg loading dose,
with upper
then 50 mg/kg q6hr

urinary tract
(usual max: 2
bleeding
g/dose) not to
(hematuria), can
exceed 12 g/day
lead to intrarenal
obstruction
Aminocaproic acid
(adult): 5 g loading
(PO or IV), then 2–5
g q6hr, titrated by
patient need

Tranexamic acid

Mucocutaneous
bleeding
Menorrhagia

Tranexamic acid:
• Avoid use with
1,300 mg PO or 10
upper urinary
mg/kg IV TID (dose
tract bleeding
reduction for
(hematuria), can