My apologies for not feeding back on this thread earlier about thrombolysing
someone with von Wiliebrands. Simon suggested angioplasty and that is
indeed what we did. Fortunately she attended during the day when the lab
was staffed so she was taken stright through for primary angioplasty. One
of our haematologists said it is very rare for soemone with vW to have an
infarct because tehy are autoprotected. There is a paper which showed
someone with haemophilia had a positive outcome and no adverse effects when
given TPA. Howvever it is so uncommon I guess it is hard to produce true
'evidence based advice' for managing this phenomenon. What would I have
done out of hours ? I suspect I would have thrombolysed her.
On the other matter of Tranexamic acid, yes in Brighton it has been in the
guidelines snce 1992. It is given as a 10ml injection over 10 minutes.
Geoff, Carlos or Steve might post the details I do not have them to hand.
John Ryan
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