• AMA with Certified Student Loan Professional

    Join SDN on December 7th at 6:00 PM Eastern as we host Andrew Paulson of StudentLoanAdvice.com for an AMA webinar. He'll be answering your questions about how to best manage your student loans. Register now!

Guy comes in w/ GI bleed

pinipig523

I like my job!
10+ Year Member
15+ Year Member
Jan 7, 2004
1,320
29
Missing Chicago
  1. Attending Physician
    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?
     

    pratik7

    Senior Member
    15+ Year Member
    Jul 10, 2003
    853
    6
    Atlanta, Ga
    1. Attending Physician
      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
       
      About the Ads

      gutonc

      No Meat, No Treat
      Staff member
      Administrator
      Volunteer Staff
      Verified Expert
      15+ Year Member
    • Mar 6, 2005
      20,066
      14,928
      1. Attending Physician
        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.
         

        Rendar5

        Full Member
        15+ Year Member
        Nov 12, 2003
        7,041
        740
        Florida
        1. Attending Physician
          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

          No Meat, No Treat
          Staff member
          Administrator
          Volunteer Staff
          Verified Expert
          15+ Year Member
        • Mar 6, 2005
          20,066
          14,928
          1. Attending Physician
            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.
             

            pinipig523

            I like my job!
            10+ Year Member
            15+ Year Member
            Jan 7, 2004
            1,320
            29
            Missing Chicago
            1. Attending Physician
              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.
               
              About the Ads
              This thread is more than 10 years old.

              Your message may be considered spam for the following reasons:

              1. Your new thread title is very short, and likely is unhelpful.
              2. Your reply is very short and likely does not add anything to the thread.
              3. Your reply is very long and likely does not add anything to the thread.
              4. It is very likely that it does not need any further discussion and thus bumping it serves no purpose.
              5. Your message is mostly quotes or spoilers.
              6. Your reply has occurred very quickly after a previous reply and likely does not add anything to the thread.
              7. This thread is locked.