Reversal of anti-coagulation and anti-plt agents continues to be a source of confusion for many of my colleagues. I am doing the podcast today in an attempt to simplify the reversal of life-threatening bleeding. In addition, I want to discuss reversal (or the lack of true need for reversal) for bedside procedures.
EMCrit Reversal Pathway for ICH and Life-Threatening Bleeding
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I-da-roo-ciz-u-mab. 🙂 (I think lol)
Thank you for the great talk. Do you consider the time of the last dose on DOAC before reversal (thinking especially > 12 hrs for apixaban or > 18-20 hrs for endoxaban/rivaroxaban).
definitely!!!
but i find I can rarely obtain this info when I really want it
I would add that even for patients on an LVAD who have a life threatening bleed you should reverse.
excellent , as always Scott. thanks.
and I agree.. a shout out for the REANIMATE course in San Diego, one of the finest things I’ve ever done.. and I don’t use ECMO. the course is ecmo, but so very much more. a gathering of some of the finest international folk.
thanks again.
Hello,
This blog really has helped me get ideas for my
college project. Thank you for sharing this article.
I’m curious on your stance on INR being the best marker for appropriate reversal? INR may be elevated and the bleed has been stabilized. The newest KCENTRA trial Proper3 looking at fixed vs variable dosing utilizes the ISTH definition for effective hemostasis over serial INR. Thanks!
Allison
thanks for bringing that paper to my attention!! I would love to see a better marker than INR, unfortunately ISTH is primarily a retrospective research definition. We would need something that can be used at the bedside in real time to supplant INR
Mohamed Abdelaziz
Thank you very much Scott that was an excellent talk particularly the GI bleeding part. I wanted to explore more about the patients on therapeutic dose Enoxaparine presenting shortly after the last dose with life threatening GI bleeding. I understand that Protamine can partially reverse that, but what else can be done to reverse their anticoagulation while preparing for a therapeutic scope.
Hey Scott,
does the algorithm discussed here address both traumatic and spontaneous bleeds for patients on anticoagulation?
Thanks in advance
Mohammed Najeebuddin
Is there a reason you haven’t included andexanet alfa?