May 29, 2023

Where there is life-threatening bleeding, anticoagulants must be reversed. Reversal agents include vitamin K, protamine, fresh frozen plasma, prothrombin complex concentrates, idarucizumab, and andexanet alfa.

Welcome to the last of our seven part series on anticoagulants in this video we discuss anticoagulant reversal let’s begin with the following take-home points if bleeding is moderate treat with activated charcoal and or fibrinolytics if bleeding is life-threatening use a reversal agent due to thrombosis risk a reversal agent should not be combined with pro-thrombin

Complex concentrates when there is moderate bleeding use oral activated charcoal to remove the unabsorbed pro drug from the gastrointestinal tract this should be attempted if the ingestion was within eight hours of rivaroxaban six hours of apixaban and two hours of edoxaban or dabigatran also treat the bleeding patient with anti-fiber analytics anti-fiber

Analytics include aminocoproic acid and tranexamic acid additional measures are required for anticoagulated patients presenting with life-threatening bleeding or needing emergency surgery if appropriate first attempt treatment with oral activated charcoal and definitely treat with anti-fiber analytics however given the life-threatening bleeding an antidote is

Indicated if one is available if no antidote is available treat with prothrombin complex concentrates or pccs let’s discuss the available reversal agents the first is vitamin k vitamin k reverses the vitamin k antagonists oral vitamin k has an onset of action of 6 to 10 hours and peaks in 24-48 hours the intravenous route has an onset of 1-2 hours and peaks in

12-14 hours next we have protamine protamine reverses heparin it is most used to reverse high-dose heparin after cardiopulmonary bypass but it can be used to reverse heparin in any setting low molecular weight heparins however are only partially reversed next are the coagulation factors these are most commonly given as fresh frozen plasma which provides factors

2 5 8 9 10 11 and antithrombin coagulation factors are also available as prothrombin complex concentrates the three factor concentrates have factors two nine and ten while the four factor concentrates include factor seven prothrombin complex concentrates can be activated or unactivated finally you can give a specific antidote the available antidotes are idler or

Suzumab for dubigatran and indexinet alpha for the direct oral 10a inhibitors note that both idyracizomab and indexing alpha increase thrombosis risk prothrombin complex concentrates also increase thrombosis risk therefore both reversal agents and prothrombin complex concentrates should not be combined let’s look at each anticoagulant and discuss its reversal

Agent unfractionated heparin is reversed by protamine low molecular weight heparins are partially reversed by protamine fonda paranox has no reversal agent vitamin k antagonists are reversed with vitamin k and four factor prothrombin complex concentrates the bigatran can be reversed with idarocysma the oral direct 10a inhibitors apixaban edoxaban and rivaroxaban

Can be reversed with andexanet alpha and the parenteral direct thrombin inhibitors our gatraban and bivalrudin have no known reversal agents in summary in an anticoagulated patient with moderate bleeding treat with activated charcoal and oral fibrinolytics where bleeding is life-threatening use a reversal agent due to thrombosis risk a reversal agent should not

Be combined with prothrombin complex concentrates this concludes our video on anticoagulants with a focus on anticoagulant reversal

Transcribed from video
Anticoagulant Reversal By Coag Coach