Bleeding uremic

Nonpharmacologic Therapy The incidence and severity of bleeding associated with uremia has decreased since dialysis has become the mainstay of treatment for ESRD. Dialysis initiation improves platelet function and reduces bleeding time.42 Improved care of the patient with ESRD, with anemia treatment and improvement in nutritional status, are also likely contributors to decreased uremic bleeding. 

Pharmacologic Therapy Treatments used to decrease bleeding time in patients with uremic bleeding include cryoprecipitate, which contains various components important in platelet aggregation and clotting, such as von Willebrand factor and fibrinogen. Cryoprecipitate decreases bleeding time within 1 hour in 50% of patients. However, cost and the risk of infection have limited the use of cryoprecipitate. 

Desmopressin (DDAVP) increases the release of factor VIII (von Willebrand factor) from endothelial tissue in the vessel wall. Bleeding time is promptly reduced, within 1 hour of administration, and is sustained for 4 to 8 hours.42 Doses used for uremic bleeding are 0.3 to 0.4 mcg/kg intravenously over 20 to 30 minutes, 0.3 mcg/kg subcutaneously, or 2 to 3 mcg/kg intranasally. Repeated doses can cause tachyphylaxis by... 

The pathophysiology of uremic bleeding is multifactorial. The primary mechanisms are platelet biochemical abnormalities and alterations in platelet-vessel wall interactions. 

Horowitz HI, Stein IM, Cohen BD, White JG (1970) Further studies on the platelet-inhibitory effect of guanidinosuccinic add and its role in uremic bleeding. Am J Med 49 336-345. 

Sloand JA. Long-term therapy for uremic bleeding. Int J Artif Organs 1996 19 439 40. 

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