Factor IX for post CPB bleeding?

[Oggg]

Anyone ever use this? Anyone know how much it costs?

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[nimbus]

Yes.....but prefer FFP when I need volume.

Page 14 has relative cost info

http://www.utexas.edu/pharmacy/divisions/pharmaco/rounds/sohraby03-09-12.pdf

http://www.psbc.org/news/pdf/2012_October_pp_Prothrombin.pdf

 

[urge]

I have only used it for hemophiliacs. I don't see much use for it otherwise. I don't tend to transfuse for coagulopathy unless bypass time is over 4 hrs. By then I think I need more than the 3 or 4 factors in the complex.

For the young bucks, don't ever say on your oral board that you are giving ffp for volume. The ASA is opposed to this practice.

 

[nimbus]

I have only used it for hemophiliacs. I don't see much use for it otherwise. I don't tend to transfuse for coagulopathy unless bypass time is over 4 hrs. By then I think I need more than the 3 or 4 factors in the complex.

For the young bucks, don't ever say on your oral board that you are giving ffp for volume. The ASA is opposed to this practice.

Guess I should clarify. If the patient is coagulopathic and hypovolemic post pump I will use FFP. If they are coagulopathic and already volume overloaded I will consider PCC.

 

[urge]

Guess I should clarify. If the patient is coagulopathic and hypovolemic post pump I will use FFP. If they are coagulopathic and already volume overloaded I will consider PCC.

I get it. Just pointing out that for the boards it is better not to mention ffp and volume in the same sentence.

 

[OB1🤙]

I probably wouldn't bother with 3 factor PCCs (i.e. Bebulin) unless the apocalypse hit and the blood bank was out of FFP. 4 factor PCCs will make sense once we get them, though cost will probably be prohibitive for routine use.

Tangentially, we're getting a ROTEM soon, which I'm happy about.

Even more tangentially, I had recently asked the hospital to supply IV fibrinogen (RiaSTAP) and was shot down for cost reasons. I pointed out the numerous instances where we were hypofibrinogenemic and the blood bank took forever to get us cryo, but they didn't seem to care. Bastards.

It's such a shame that Europe is years ahead of us in terms of using these products.

That said, it's now a minority of our patients that get transfused at all, so we're making good progress regardless.

 

[urge]

Even more tangentially than tangiential, TEG/Rotem results have been a disappointment for me.

 

[OB1🤙]

Can you elaborate?

 

[Laryngophed]

I probably wouldn't bother with 3 factor PCCs (i.e. Bebulin) unless the apocalypse hit and the blood bank was out of FFP. 4 factor PCCs will make sense once we get them, though cost will probably be prohibitive for routine use.

Tangentially, we're getting a ROTEM soon, which I'm happy about.

Even more tangentially, I had recently asked the hospital to supply IV fibrinogen (RiaSTAP) and was shot down for cost reasons. I pointed out the numerous instances where we were hypofibrinogenemic and the blood bank took forever to get us cryo, but they didn't seem to care. Bastards.

It's such a shame that Europe is years ahead of us in terms of using these products.

That said, it's now a minority of our patients that get transfused at all, so we're making good progress regardless.

My home institution just got a TEG. I scheduled a rotation in blood bank/coag just to learn to interpret them. I figured I could do a lot worse as a 4th year than learn something about transfusion medicine.

 

[urge]

Can you elaborate?

TEG/Rotem don't correlate with bleeding in my experience. You can have a good teg/bleeding as well as bad teg/no bleeding and every random combination you can imagine.

Plus, it takes too long. By the time you get the result back the coagulation profile has already worsened in bleeding patients.

My observation has been that people who treat abnormal tegs over transfuse compared to people who just ignore it.

 

[OB1🤙]

Interesting. Thanks. Will take things with a grain of salt.

 

[urge]

Interesting. Thanks. Will take things with a grain of salt.

Give it a try and arrive at your own conclusions. Report back in a few months.