| Antifibrinolytics | Include ε-aminocaproic acid and tranexamic acid |
| Interfere with the formation of the fibrinolytic enzyme plasmin from its precursor plasminogen | |
| First-line therapy in rare disorders of fibrinolysis (α2-antiplasmin and PAI-1 deficiencies)56 | |
| Systemic or topical antifibrinolytics may be used alone to treat or prevent mucosal bleeding in patients with coagulation factor disorders, thus avoiding systemic hemostatic therapies1,66–68,73 | |
| Effective, first-line therapy for menorrhagia (with or without hormonal therapies)25,80,85 | |
| Tranexamic acid used anecdotally in patients with bleeding disorders, including as an adjunct to factor replacement for major surgery in patients with hemophilia78,81,84 and as a sole systemic hemostatic agent primarily for minor procedures1,66 | |
| Also used for treatment of bleeding and for hemostatic coverage for minor surgery in patients with platelet function disorders; may be used adjunctively with platelet transfusion and other nontransfusional therapies in these patients83 | |
| Theoretical risk for thrombogenesis; may be increased in patients who receive concurrent factor replacement or who have certain bleeding disorders (eg, dysfibrinogenemia, in which antifibrinolytics are contraindicated) | |
| Desmopressin | Transiently increases VWF and FVIII levels89 and augments platelet adhesiveness and aggregation68 |
| Agent of choice for treatment or prevention of bleeding in most patients with type 1 VWD; however, patients with type 3 VWD and most patients with type 2 VWD typically require factor concentrates containing FVIII and VWF90 | |
| Other desmopressin-responsive bleeding disorders include mild hemophilia A and platelet function disorders, in which the use of desmopressin for surgical coverage has been described21,87; also commonly used for uremic bleeding88 | |
| Specifically used for treatment of menorrhagia in women with bleeding disorders25,80,91 | |
| Patients, especially children, receiving desmopressin should be closely monitored for hyponatremia22,87 | |
| Vitamin K | May be used in vitamin K deficiency and for bleeding caused by overmedication with warfarin |
| Widely available and inexpensive | |
| Should be given intravenously or orally (not subcutaneously) for best absorption and fastest response92–94 |
FVIII, factor VIII; PAI, plasminogen activator inhibitor; VWD, von Willebrand disease; VWF, von Willebrand factor.