BNF for Children 2011-2012

124 2.11 Antifibrinolytic drugs and haemostatics BNFC 2011–20122 Cardiovascular systemCyklokapron c (Meda) ATablets, f/c, scored, tranexamic acid 500 mg, netprice 60-tab pack = £14.30Cyklokapron c (Pfizer) AInjection, tranexamic acid 100 mg/mL, net price 5-mL amp = £1.55Blood productsThese products should be used on the advice of ahaematologist.DRIED PROTHROMBIN COMPLEX(Human Prothrombin Complex)Dried prothrombin complex is prepared from human plasma bya suitable fractionation technique, and contains factor IX,together with variable amounts of factors II, VII, and XCautions risk of thrombosis; disseminated intravascularcoagulation; history of myocardial infarction orcoronary heart disease; postoperative use; vaccinationagainst hepatitis A (p. 607) and hepatitis B(p. 608) may be requiredContra-indications angina; recent myocardial infarction(except in life-threatening haemorrhage followingoverdosage of oral anticoagulants, and before inductionof fibrinolytic therapy); history of heparininducedthrombocytopeniaHepatic impairment monitor closely (risk of thromboemboliccomplications)Side-effects thrombotic events (including disseminatedintravascular coagulation); rarely headache;very rarely pyrexia, antibody formation, hypersensitivityreactions (including anaphylaxis); nephroticsyndrome also reportedIndication and doseTreatment and peri-operative prophylaxis ofhaemorrhage in congenital deficiency of factorsII, VII, IX, or X if purified specific coagulationfactors not available, treatment and perioperativeprophylaxis of haemorrhage inacquired deficiency of factors II, VII, IX, or X(e.g. during warfarin treatment—see section2.8.2)Consult haematologistAvailable from CSL Behring (Beriplex c P/N), Octapharma(Octaplex c )FACTOR VIIa (RECOMBINANT)Eptacog alfa (activated)Cautions risk of thrombosis or disseminated intravascularcoagulationSide-effects very rarely nausea, thrombotic events(including myocardial infarction and cerebrovascularaccident), coagulation disorders, fever, pain, andallergic reactions including rashIndication and doseTreatment and prophylaxis of haemorrhage inhaemophilia A or B with inhibitors to factorsVIII or IX, acquired haemophilia, factor VIIdeficiency, or Glanzmann’s thrombastheniaConsult haematologistAvailable from Novo Nordisk (NovoSeven c T)FACTOR VIII FRACTION, DRIED(Human Coagulation Factor VIII, Dried)Dried factor VIII fraction is prepared from human plasma by asuitable fractionation technique; it may also contain varyingamounts of von Willebrand factorCautions monitor for development of factor VIII inhibitors;intravascular haemolysis after large or frequentlyrepeated doses in patients with blood groupsA, B, or AB—less likely with high potency concentrates;vaccination against hepatitis A (p. 607) andhepatitis B (p. 608) may be required (not necessarywith recombinant preparation)Side-effects gastro-intestinal disturbances, taste disturbances;flushing, palpitation; dyspnoea, coughing;headache, dizziness, paraesthesia, drowsiness; blurredvision; antibody formation; hypersensitivity reactionsincluding hypotension, angioedema, chills, fever,urticaria, and anaphylaxisIndication and doseTreatment and prophylaxis of haemorrhage incongenital factor VIII deficiency (haemophiliaA), acquired factor VIII deficiency, or von Willebrand’sdiseaseConsult haematologistAvailable from Biotest UK (Haemoctin c T), CSL Behring(Haemate c P), BPL (Optivate c ; 8Y c ), Grifols (Alphanate c ;Fanhdi c ), Octapharma (Octanate c ; Wilate c T);Haemoctin c , Optivate c , Fanhdi c , and Octanate c are notindicated for use in von Willebrand’s diseaseNote Preparation of recombinant human coagulation factorVIII (octocog alfa) available from CSL Behring (Helixate cNexGen), Baxter (Advate c ), Bayer Schering(Kogenate cBayer); preparation of recombinant human coagulationfactor VIII (moroctocog alfa) available from Wyeth (ReFactoAF c T); octocog alfa and moroctocog alfa are not indicatedfor use in von Willebrand’s diseaseFACTOR VIII INHIBITOR BYPASSINGFRACTIONPreparations with factor VIII inhibitor bypassing activity areprepared from human plasmaCautions vaccination against hepatitis A (p. 607) andhepatitis B (p. 608) may be requiredContra-indications disseminated intravascular coagulationSide-effects thrombosis, disseminated intravascularcoagulation, myocardial infarction; paraesthesia;pyrexia; hypersensitivity reactions including hypotension,flushing, urticaria, rash, and anaphylaxisIndication and doseTreatment and prophylaxis of haemorrhage incongenital factor VIII deficiency (haemophiliaA) and factor VIII inhibitors; treatment ofhaemorrhage in non-haemophiliac childrenwith acquired factor VIII inhibitorsConsult haematologistAvailable from Baxter (FEIBA c )FACTOR IX FRACTION, DRIEDDried factor IX fraction is prepared from human plasma by asuitable fractionation technique; it may also contain clottingfactors II, VII, and XCautions risk of thrombosis—principally with formerlow purity products; vaccination against hepatitis A(p. 607) and hepatitis B (p. 608) may be required (notnecessary with recombinant preparation)Contra-indications disseminated intravascular coagulation