Trauma Guideline Manual - SUNY Upstate Medical University

126____________ Trauma Guidelines ManualSUNY Upstate Trauma Centerc. If patient has mechanical heart valve consider starting heparin (PTT 45 -55) 48hours post-injury and restarting Coumadin 7 days post-injury.d. Consider vena cava filter if DVT/PE is reason for anticoagulation; discontinueanticoagulation until 7 days post-injury.3. Specific Therapy( Link to UUH anticoagulation guideline)a. Acute Reversal of Patients Receiving Coumadini. FFP: give 2 units and follow INR; target INR 50% factor activity. If risk is Moderate or Low, check Factorlevels and dose accordingly. Monitor PTT and consult hematology.ii. One unit/kg will raise Factor levels by 2%.iii. In order to obtain 50% Factor activity (assuming low patient factor levels)begin with 40 units/kg every 12 hours (especially for CNS injury, seeDefinition section) and obtain hematology consult. Therapeutic goal is>50% factor activity and 80% for CNS injury.d. Von Willebrand’s Diseasei. Bleed risk is Moderate to Low unless patient has severe von Willebrand’sDisease.ii. Give cryo-precipitated vWF–enriched plasma; monitor PTT and bleedtime; obtain hematology consult. Goal is >25% Factor activity.e. Hemophilia Bi. Bleed risk is Moderate to Low, therefore replace Factor IX using serumfactor levels (goal is >50% factor activity; 80% for CNS) and clinicalevaluation. One unit/kg of factor IX will increase Factor activity by 1%.ii. For serious bleeding, start with 60 units/kg BIDiii. Obtain hematology consult.f. Factor V Deficiencyi. Treat with Factor V Replacement, usually via FFP transfusion (begin with2 units).ii. Obtain hematology consult.g. Functional Platelet Defects and Thrombocytopenia (platelet count < 20,000)