Abstract
Owing to the propensity of anticoagulated patients to bleed, a strategy for reversal of anticoagulation induced by any of the common agents is essential. Many patients are anticoagulated with a variety of agents, including warfarin, low molecular weight heparin, and the direct oral anticoagulants such as factor Xa and factor IIa inhibitors. Patients may also be using antiplatelet agents. Recommendations to reverse bleeding in these patients are constantly evolving with the recent development of specific reversal agents. A working knowledge of hemostasis and the reversal of anticoagulation and antiplatelet drugs is required for every emergency department provider. This article reviews these topics and presents the currently recommended strategies for dealing with bleeding in the anticoagulated patient.
Highlights
Inappropriate bleeding is the most concerning complication of anticoagulant therapy
Activated Partial Thromboplastin Time The aPTT is a measure of the contact activation coagulation pathway; aPTT becomes prolonged in patients on heparin
Activated prothrombin complex concentrates (PCCs), known as “factor VIII inhibitor bypassing activity” (FEIBA), has been shown in animals to lessen bleeding and correct endogenous thrombin potential, which represents the amount of thrombin that can be generated after coagulation is activated by tissue factor in vitro.[29] aPCC contains variable amounts of activated clotting factors with most of the activation occurring with factor VII
Summary
Owing to the propensity of anticoagulated patients to bleed, a strategy for reversal of anticoagulation induced by any of the common agents is essential. Many patients are anticoagulated with a variety of agents, including warfarin, low molecular weight heparin, and the direct oral anticoagulants such as factor Xa and factor IIa inhibitors. Recommendations to reverse bleeding in these patients are constantly evolving with the recent development of specific reversal agents. A working knowledge of hemostasis and the reversal of anticoagulation and antiplatelet drugs is required for every emergency department provider. This article reviews these topics and presents the currently recommended strategies for dealing with bleeding in the anticoagulated patient. This article reviews these topics and presents the currently recommended strategies for dealing with bleeding in the anticoagulated patient. [West J Emerg Med. 2019;20(5)770-783.]
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