Management of coagulation: an Australian perspective

New anticoagulants and new techniques bring challenges and opportunities to the practice of anaesthesia. Existing guidelines may not be up-to-date with these changes, so this review will examine the current research with a view to identifying deficiencies in existing guidelines, particularly those that may guide Australian anaesthetists.

The novel oral anticoagulants dabigatran and rivaroxaban, and the potent antiplatelet agents ticagrelor and prasugrel are available in Australia. Considerable research data support the benefit of using these drugs, but the risk profile is incompletely understood. The concept of damage control resuscitation is supported by plentiful, but potentially flawed, observational data, and also the technique may be associated with adverse effects. It remains difficult to firmly quantify the risks of using tranexamic acid or recombinant factor 7a in many clinical situations.

Despite much interesting recent research, few current guidelines are likely to require modification. Novel pharmaceuticals have risk profiles that are incompletely understood, but will only become evident on phase-4 testing. Australasian guidelines for reversal of warfarin may need to be updated to include advice on the use of recombinant factor 7a.