Evaluation of Emergency Medicine Pharmacist Participation in Time to Oral Anticoagulation Reversal: A Systematic Review and Meta-Analysis

Intracranial and extracranial hemorrhages are significant causes of morbidity and mortality. Emergency medicine pharmacists (EMPs) can play a crucial role in anticoagulation reversal by identifying patients on anticoagulation, selecting the optimal anticoagulation reversal agent, and ensuring adequate dosing and prompt administration. The goal of this systematic review and meta-analysis was to determine the impact EMPs have on time to anticoagulation reversal and patient outcomes in anticoagulation-associated hemorrhages.

A medical librarian performed a literature search in EBSCO CINAHL, Ovid Cochrane Central Register of Controlled Trials, Ovid Embase, Ovid Medline, Scopus, and Web of Science Core Collection from inception to January 2025 for all types of oral anticoagulants and for life-threatening bleeding that required emergent reversal. Newcastle-Ottawa was used to assess the risk of bias, and Grading of Recommendations Assessment, Development, and Evaluation (GRADE) was used to assess the level of certainty of the evidence. Random effects models estimating mean differences and 95% confidence intervals are reported.

There were 2445 titles and abstracts screened, with 44 undergoing full-text evaluation. Six observational studies including 219 patients who received an anticoagulation reversal agent with the presence of an EMP and 198 patients who received a reversal agent without an EMP were included. Time from emergency department (ED) presentation to anticoagulation reversal agent administration (75.60 min, 95% confidence interval [CI]: -101.7 to -49.5) and time from medication order to administration were faster with an EMP (-18.7 min, 95% CI: -23.5 to -14.0). There was no difference in short-term mortality. The included studies had a high risk of bias and were deemed very low quality of evidence.

EMP involvement in patient care during anticoagulation reversal of acute hemorrhages improved time to anticoagulation reversal agent administration. Larger scale, higher-quality studies are necessary to assess the value of EMPs in improving patient-centered outcomes.