2.11 Antifibrinolytic drugs and haemostatics
Aprotinin (injection) is used for blood conservation in patients undergoing open heart surgery. Note: The CHM has advised that the licences of aprotinin will be suspended from 7 December pending the outcome of a Europe-wide review of the balance of risks and benefits of aprotinin [ MHRA advice].
Tranexamic acid (tablets, injection) is used to inhibit clot breakdown in patients with bleeding disorders and to treat haemorrhage after streptokinase administration.
Desmopressin (injection) is used to promote release of Factor VIII in mild/moderate haemophilia.
Adrenaline/epinephrine 1 in 1000 (topical solution) is a potent vasoconstrictor, which may be applied topically to mucous membranes and exposed tissues. It can check capillary bleeding, epistaxis and bleeding from superficial wounds and abrasions. It is not suitable for administration by injection (see also 3.4.3 and 2.1/7).
List of commercial coagulation factors and blood products held in ARI Pharmacy.
1. Factor VIII Fraction, Dried
Recombinate® - Baxter Bioscience
Kogenate Bayer® - Bayer
Helixate Nextgen® - Aventis Behring
Refacto® - Wyeth
These recombinant preparations are indicated specifically for the prevention and treatment of haemorrhage in congenital haemophilia-A. Their use should always be guided by an expert in haemophilia/haemostasis.
2. Factor IX Fraction, Dried
HT Defix® - SNBTS
Is the treatment of choice for severe warfarin overdose. It is available from the Blood Transfusion Department only.
BeneFIX® - Baxter Bioscience
This is the only available recombinant coagulation Factor IX preparation. It is indicated specifically for the prevention and treatment of haemorrhage in congenital haemophilia B. Its use should always be guided by an expert in haemophilia/haemostasis.
3. Products for the treatment of patients with inhibitors (allo or auto)
a) Human Factor VIII Inhibitor Bypassing Fraction - FEIBA® (Baxter Bioscience). FEIBA® is inactivated prothrombin complex concentrate which can be used to induce haemostasis in patients with anti-Factor VIII antibodies. It is a pooled human donor product and therefore carries with it the potential risk of infection carried by the donors contributing to the plasma pool from which it was derived. Its use is highly specialised and should always be guided by an expert in haemophilia/haemostasis.
b)Recombinant VIIa - NovoSeven® (Novo Nordisk). This is a recombinant activated Factor VII product which can be used to secure haemostasis in patients with anti-Factor VIII antibodies. Its use should always be guided by an expert in haemophilia/haemostasis.
4. Products for patients with von Willebrand's disease
Haemate® P (ZLB Behring). Haemate® P is an intermediate purity Factor VII concentrate with a high concentration of von Willebrand Factor which may be used for the prevention and treatment of haemorrhage in patients with von Willebrand's disease. As a pooled human blood product this is associated with a small risk of transmission of transfusion-transmitted infections. Its use should always be guided by an expert in haemophilia/haemostasis.
5. Products for patients with Factor XIII deficiency
Fibrogrammin® P (ZLB Behring). This is a Factor XIII concentrate made from the plasma of human donors. It is a pooled product which is associated with a small risk of the transmission of transfusion-associated infections. It is only indicated for prevention and treatment in individuals with congenital Factor XIII deficiency. Its use should be guided by an expert in haemophilia/haemostasis.
6. Commercial pooled intravenous immunoglobulin products
Flebogamma® (Grifols). Commercial intravenous immunoglobulin is available for use in situations where it is deemed to be the product of choice or where there is intolerance to SNBTS intravenous immunoglobulin products. The product is licensed for use in primary and secondary immunodeficiencies and for the treatment of ITP. Its use for these licensed indications should, where possible, be decided in consultation with a consultant immunologist or haematologist. Appropriate arrangements should be made for its use off-licence.