Table 8 Oncologic considerations for bleeding in the ICU
Drug | Primary role in therapy | Dosing and administration | Monitoring, adverse events, and toxicities | Drug-drug interactions | Clinical pearls |
|---|---|---|---|---|---|
DAH, oral bleeding with thrombocytopenia | Dosing DAH: IV: 4 g over 1 h, followed by continuous infusion at 1 g/h Topical for oral bleeding with thrombocytopenia : Rinse with hydrogen peroxide, then rinse with saline, followed by a third rinse with 5 ml (1.25 g) aminocaproic acid syrup for 30 sec. Repeat q4h until bleeding controlled Administration Rapid IV administration can result in hypotension, bradycardia, and/or arrhythmias | Monitoring CPK, heart rate agranulocytosis, signs and symptoms of VTE AE/toxicities Bradycardia, arrhythmias, VTE | • May accumulate in renal failure. Specific guidelines for dosage adjustments are unavailable; dose should be modified based on clinical response and degree of renal impairment | ||
DAH, thrombocytopenia-related bleeding | Dosing Minimal dosing recommendations We recommend IV/PO/PT: TXA 10–15 mg/kg q8-12 h Alternate dosing regimens: Hemoptysis: 250–500 mg TXA in 500 mg/5 mL solution nebulized via facemask over 15 min Administration Hypotension can occur when infusion rates exceed 100 mg/min | AE/toxicities VTE, abdominal pain, back pain, musculoskeletal pain, myalgia | • Accumulates in renal failure. Dose adjustment needed. See package insert. | ||
Refractory bleeding | Dosing Life-threatening bleeding: IV: 35–120 mcg/kg q2h up to 4 doses per day. Usual starting dose was 75 mcg/kg | Monitoring aPTT, DIC AE/toxicities Thromboembolism |