Anticoagulant reversal
See Warfarin
Usually in the context of Massive haemorrhage/Impending bleeding doom, in the midst of resuscitation with blood products, controlling the source etc.
key questions
- why are they on an anticoagulant?
- any other factors affecting clotting? - antiplatelets, liver failure, etc.
- is this a major bleed?
Contact pharmacy EARLY
Xa inhibitors
| Agent | t½ |
|---|---|
| Apixaban | 6-15h |
| Rivaroxaban | 5-12h |
| Edoxaban |
Apixaban, rivaroxaban only: reverse with Adnaxet Alfa
only if any uncontrolled or life-threatening bleeding in the gastrointestinal tract
Administration: bolus then infusion
Alternative: prothrombin concentrate
edoxaban has no reversal agent
direct thrombin inhibitor
Dabigatran: t½ = 12-17h
reversal agent: Idarucizumab
emergency surgery or urgent procedures or in life-threatening bleeding
heparins
reversal
protamine sulphate