We are frequently faced with patients who require anticoagulation reversal due to hemorrhage or an emergent procedure. This has grown rather complicated, due to the emergence of numerous new anticoagulants and reversal agents. Furthermore, new evidence is emerging regarding the reversal of old agents (e.g. the PATCH trial regarding platelet transfusion in patients on aspirin). This chapter will strive to be a one-stop-shop where all this information is collected and updated (because it's humanly impossible to remember all this stuff).
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The IBCC chapter is located here.
- The podcast & comments are below.
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Josh is the creator of PulmCrit.org. He is an associate professor of Pulmonary and Critical Care Medicine at the University of Vermont.
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Link to fixed-dose post is no longer valid, so can find updated link here: https://empharmd.com/2017/10/26/ftfy-prothrombin-complex-concentrate-that-is/
Thanks – I fixed the link. If there are any updates please let me know so we can keep it up to date.
Great Review
Great review as always. Only comment is on protamine. In the heart rooms we routinely give very large doses to reverse the profound heparinization used for cardiopulmonary bypass. 250 mg is a pretty standard starting dose, and it’s very common to have to give more. In the ICU it’d certainly be unusual to give more than 50 mg, but it might not be unreasonable in select circumstances. The half life however, is much shorter than 2 hours in this population (around 5 minutes, https://www.ncbi.nlm.nih.gov/pubmed/12440613, perhaps a few minutes longer in healthy volunteers). This is relevant because sequestered heparin can leak… Read more »
I am a little confused about why irreversible platelet inhibitors lend themselves more towards reversal than reversible platelet inhibitors. If any of these drugs are in patient’s body, the transfused platelets are going to be essentially useless, right (for both reversible and irreversible)? Thanks for everything you do and would love some more insight into this.
Very informative chapter. Big fan and frankly can’t wrap my head around how prolific you are in reviewing all these different topics and putting out such amazing synopses at the rate u publish them.
Wanted to point out an erratum: in the tpa reversal list u put cryoglobulin where I think u meant to say cryoprecipitate and also in the podcast both Adam Thomas and u referred to cryoglobulin