Guy comes in w/ GI bleed

[pinipig523]

So I have a guy w/ a GI bleed - likely from lovenox for a clot in the scv + Rt IJ found on a prior admission.

Other than getting red units in, is there anything I can give to slow down the bleed?

I know protamine does not work as well against lovenox as it does against heparin... does FFP have any benefit?

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[pratik7]

So I have a guy w/ a GI bleed - likely from lovenox for a clot in the scv + Rt IJ found on a prior admission.

Other than getting red units in, is there anything I can give to slow down the bleed?

I know protamine does not work as well against lovenox as it does against heparin... does FFP have any benefit?

protamine will reverse about 66% of the lovenox

 

[iDoc1]

Not sure that FFP has a role here

 

[gutonc]

Note: I'm hem/onc, not EM.

Both of the above are true. And yet, most of these guys will get whatever is available to make them stable. If bleeding profusely, protamine and FFP. No data to support the FFP but even our benign heme superstars still tell us to give it in this setting. I would also support checking a lovenox level if available. It can give you some idea of how much effect the lovenox is having on the bleeding.

 

[xaelia]

Change "lovenox" to "dabigatran" in the clinical case, and now you have an interesting GI bleed.

Of course, "all bleeding stops".

 

[Rendar5]

Note: I'm hem/onc, not EM.

Both of the above are true. And yet, most of these guys will get whatever is available to make them stable. If bleeding profusely, protamine and FFP. No data to support the FFP but even our benign heme superstars still tell us to give it in this setting. I would also support checking a lovenox level if available. It can give you some idea of how much effect the lovenox is having on the bleeding.

for really bad bleeding, FFP complements pRBC's anyway, although that lit is more related to trauma.

 

[gutonc]

Change "lovenox" to "dabigatran" in the clinical case, and now you have an interesting GI bleed.

Of course, "all bleeding stops".

True and true.

 

[gutonc]

for really bad bleeding, FFP complements pRBC's anyway, although that lit is more related to trauma.

Agreed. But lacking any other real data, we tend to bastardize the trauma/bleeding literature to every other "holy sh** that's a lot of blood" situation.

 

[Apollyon]

Every time I see the title of this thread, I am wondering what the second half of the joke is.

"Guy comes in with a GI bleed. I say 'hematochezia'. He says, 'Like Provolone?'"

 

[pinipig523]

Note: I'm hem/onc, not EM.

Both of the above are true. And yet, most of these guys will get whatever is available to make them stable. If bleeding profusely, protamine and FFP. No data to support the FFP but even our benign heme superstars still tell us to give it in this setting. I would also support checking a lovenox level if available. It can give you some idea of how much effect the lovenox is having on the bleeding.

Yes, this is exactly what our heme consult asked us to do. Give both.