Reversing anticoagulation in the hemorrhaging patient
Benedikt Treml1, Elgar Oswald, Bettina Schenk
1Department of General and Surgical Intensive Care Medicine, Medical University of Innsbruck, Innsbruck, Austria.
Current Opinion in Anaesthesiology
|March 1, 2019
Summary
Reversing anticoagulation in bleeding patients is challenging. Specific antidotes are preferred, followed by prothrombin complex concentrate (PCC) or other agents, guiding emergency strategies for safer patient outcomes.
Area of Science:
- Pharmacology
- Hematology
- Emergency Medicine
Background:
- Direct oral anticoagulants and platelet inhibitors present significant challenges in managing hemorrhaging patients.
- Effective reversal strategies for these anticoagulants are crucial for patient safety.
Purpose of the Study:
- To review recent studies on reversing anticoagulation in hemorrhaging patients.
- To outline a therapeutic emergency strategy for managing such cases.
Main Methods:
- Literature review of recent studies on anticoagulant reversal.
- Description of a clinical emergency strategy.
Main Results:
- A specific antidote for dabigatran is available; others for factor Xa inhibitors are in development.
- Bleeding under platelet inhibitors lacks effective reversal evidence.
Conclusions:
- Specific antidotes are the first choice for reversing anticoagulation, followed by four-factor prothrombin complex concentrate (PCC), activated PCC, and recombinant activated factor seven.
- Fibrinogen concentrate, antifibrinolytics, and oral charcoal can be used as additional measures.
- Massive blood loss and thrombocytopenia require independent management according to transfusion guidelines.
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