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Treatment of bleeding

Symptomatic carriers and women with hemophilia usually don’t experience symptoms on a daily basis. They may, however, experience prolonged bleeding after an accident or medical intervention. When this happens, they must be treated in the same way as men with hemophilia. Treatment options include:

Desmopressin

Desmopressin is a synthetic hormone that may help control bleeding in an emergency or during surgery. It can be injected intravenously, administered under the skin (subcutaneously), or given as a nasal spray.

Desmopressin does not work for everyone. All carriers of hemophilia A with clotting factor levels of less than 50 per cent should have their response to the medication tested before they need to use it. Desmopressin is not effective in carriers of hemophilia B, as it does not raise levels of factor IX.

Desmopressin should not be used in some instances, for example in cases of head trauma and in women who are at risk of heart problems. Doctors should be familiar with the medication and how it should be used before prescribing it.

Clotting factor concentrates

In carriers for whom desmopressin doesn’t work or is not recommended, infusions of clotting factor concentrates may be necessary when the risk of severe bleeding is high, such as before or during surgery.

Antifibrinolytic agents

The antifibrinolytic drugs tranexamic acid and aminocaproic acid are used to prevent the breakdown of blood clots in certain parts of the body such as the mouth and uterus. They can be used to control heavy menstrual bleeding and during minor surgeries and dental procedures.

Hormone therapy

Hormone therapy can be used to help control excessive menstrual bleeding. This includes combined hormonal contraceptives (which can be given orally, as skin patches, or vaginally) and the levonorgestrel-releasing intrauterine device/system (IUD or IUS).

Surgical options for menorrhagia

Some women will continue to experience heavy menstrual bleeding, even with these medications. Though there are always some risks involved in surgery, procedures such as uterine (or endometrial) ablation and hysterectomy may be considered in rare circumstances.


Updated November 2012