MTP Octaplex rFVIIa Calgary - PowerPoint PPT Presentation

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MTP Octaplex rFVIIa Calgary

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  1. MTP Octaplex rFVIIa Calgary

  2. Massive Transfusion Protocol Massive Transfusion Protocol

  3. “The treatment for bleeding is to stop the bleeding”

  4. MTP - Trigger 4 units in 4 hours -> 6 units in 4 hours AND ongoing major bleeding

  5. MTP Pack (1:1:1 Ratio) • 6 U RBCs • 6 U FFP ** • 1 Dose Platelets

  6. MTP - FFP Facts no typing = 4 units only thawed product = no delay at FMC and PLC • 30 min delay at RVH

  7. Patient Considerations • Acidosis (pH 7.2) • Hypocalcemia ( 1.2 mmol/L) • Hypothermia (35°C) • Heparin Reversal – Protamine • Warfarin Reversal – Octaplex and Vit K • CRF - DDAVP

  8. MTP - Other Products to Consider • Cryoprecipitate • Fibrinogen < 1g/L • Tranexamic Acid • Niastase

  9. MTP Usage 2008-2010 115 activations: • 95 FMC • 12 PLC • 5 ACH • 3 RGH

  10. MTP - Improvements and Future • no sample • premature activation • premature call for second pack • ? Tranexamic acid (Crash 2)

  11. Octaplex Prothrombin Complex concentrate: II, VII, IX, X, protein C and S and heparin sodium citrate

  12. Octaplex Indications • reversal of warfarin therapy or Vit K deficiency: • major life threatening bleeding • requiring urgent (<6 hour) surgical procedure

  13. Contraindicated in patients with history of heparin induced thrombocytopenia

  14. Not Recommended • elective reversal of OAT pre-invasive procedure • tx of INRs without bldg or need for sx • massive transfusion • coagulopathy with liver dysfunction • recent hx thrombosis, MI, ischemic stroke or DIC ** case by case decisions**

  15. Octaplex Dosing and Administration • 1st dose is 1000 IU (2 vials) • 1 ml/min X 10 min then 3ml/min • Vit K 10 mg IV • 2nd dose of 1000 IU at 15 min prn • 3rd dose requires documentation of INR >1.5

  16. Octaplex - Monitoring Effect • INR 15 min post • INR 5-6 hr post

  17. Octaplex - Calgary Numbers March 2009 to August 2010 • 230 doses (1000 IU) in 216 pts • good response to single dose (INR < 1.6) • 77% overall • 80% CNS hemorrhage • 92% of patients with a N PTT

  18. Octaplex – Calgary Experience • suggest increased initial dose (60ml = 1500 IU) • elevated PTT (any abnormal level) (only 65% corrected) • INR >3.5. (only 38% corrected) Do we need to also monitor PTT?

  19. rFVIIa (Niastase®) • recombinant protein • 1996 licensed: “for prevention of bleeding connected with surgery in pts with hemophilia with inhibitors to factor VIII”

  20. Is it a waste of time?

  21. Is it dangerous? +

  22. rFVIIa (NiaStase RT®) trauma, massive periopbld, obstetrical bleeding AND transfusion more than one blood volume AND massive ongoing bleeding AND good clinical outcome possible

  23. Niastase Adequate hemostatic measures taken: Antifibrinolytics Surgical hemostasis Aggressive component support to INR >1.5 Fibrinogen > 1.0 g/L Platelet count >50

  24. Niastase High risk populations considered • Age >65 • Hx atherosclerosis • Artificial grafts or heart valves • Prevhx VT or AT • Hereditary thrombophilic states • Sickle cell • Sepsis/DIC or other acquired thrombophilic state

  25. Niastase • Initial dose 40 ug/kg • About 3mg for average adult • May be repeated at 30 min and 2 hours

  26. Niastase • Vials are 1, 2, 5 mg • No need for refrigeration (new)