Minor bleeding

Primary therapy is based on disease severity and type of hemorrhage.7 Most patients with mild to moderate disease and a minor bleeding episode can be treated with l-desamino-8-D-arginine vasopressin [desmopressin acetate (DDAVP)], a synthetic analog of the antidiuretic hormone vasopressin. DDAVP causes release of von Willebrand factor (vWF) and factor VIII from endogenous storage sites. This formulation increases plasma factor VIII levels by three- to fivefold within 30 minutes. The recommended dose is 0.3 mcg/kg intravenously (in 50 mL normal saline infused over 15 to 30 minutes) or subcutaneously or 300 meg intranasally via concentrated nasal spray every 12 hours. Peak effect with intranasal administration occurs 60 to 90 minutes after administration, which is somewhat later than with intravenous administration. Desmopressin infusion may be administered daily for up to 2 to 3 days. Tachyphylaxis, an attenuated response with repeated administration, may occur after several doses.8... 

Most patients with type 1 vWD (functionally normal vWF) and a minor bleeding episode can be treated successfully with desmopressin, which induces secretion of autologous factor VIII and vWF into plasma. The recommended dose is the same as that used to treat mild factor VIII deficiency (0.3 mcg/kg intravenously in 50 mL of normal saline infused over 15 to 30 minutes). This therapy generally is ineffective in type 2A patients who secrete qualitatively abnormal vWF and is controversial in type 2B patients because it may increase the risk of postinfusion thrombocytopenia. Type 3 vWD patients who lack releasable stores of vWF do not respond to DDAVP therapy.18... 

Adverse reactions occurring in 3% or more of patients include anemia, bullous eruption, confusion, constipation, dizziness, edema, fever, headache, hypokalemia, hypotension, increased wound drainage, insomnia, major/minor bleeding, nausea, purpura, rash, urinary tract infection, vomiting. 

Major Bleeding (p = NS) Minor Bleeding (p = 0.09) Transfusions (p = 0.11) Abciximab Placebo... 

Minor bleeding can be stopped with plasma factor levels of 25-30% but severe bleeding requires a level of at least 50% and surgical... 

Note Minor bleeding can be stopped easily be applying concentrated ferric chloride solution or alum. 

Treatment with l-desamino-8-D-arginine vasopressin (desmopressin acetate) is often adequate for minor bleeding episodes in patients with... 

Oral mucosa 30%-50% May try antifibrinolytic or topical thrombin prior to factor replacement for minor bleeding higher factor levels may be needed for tongue swelling or risk of airway compromise antifibrinolytic therapy should be used following factor replacement do not use with APCCs or PCCs... 

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