Reversal of Anticoagulation and Management of Bleeding in Patients on Anticoagulants

Prajwal Dhakal; Supratik Rayamajhi; Vivek Verma; Krishna Gundabolu; Vijaya R Bhatt

doi:10.1177/1076029616675970

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Reversal of Anticoagulation and Management of Bleeding in Patients on Anticoagulants

Journal article

Open access

Peer reviewed

Reversal of Anticoagulation and Management of Bleeding in Patients on Anticoagulants

Prajwal Dhakal, Supratik Rayamajhi, Vivek Verma, Krishna Gundabolu and Vijaya R Bhatt

Clinical and applied thrombosis/hemostasis, Vol.23(5), pp.410-415

07/2017

DOI: 10.1177/1076029616675970

PMID: 27789605

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Abstract

Bleeding is the most common complication of all anticoagulants. Any bleeding patient on an anticoagulant should be risk-stratified based on hemodynamic instability, source of bleeding, and degree of blood loss. Although minor bleed may be managed with discontinuation of anticoagulant, major bleed may require transfusion of blood products and use of specific antidote. The residual effects of each anticoagulant may be monitored with distinct coagulation assay. Intravenous or oral vitamin K can reverse the effect of warfarin within 24 to 48 hours and is indicated for any bleeding, international normalized ratio of >10 or 4.5 to 10 in patients with other risk factors for bleeding. Fresh frozen plasma or prothrombin complex concentrate (PCC) may be necessary in major bleeding related to warfarin. Protamine sulfate reverses the effect of unfractionated heparin completely and of low-molecular-weight heparin (LMWH) partially. Idarucizumab has recently been approved in United States for dabigatran reversal, whereas andexanet alfa is expected to get approved in the near future for reversal of oral factor Xa inhibitors. The PCC may reverse the effect of rivaroxaban to some extent, but no data are available regarding reversal of apixaban and edoxaban. Aripazine has shown promising results to reverse the effects of LMWH, fondaparinux, and direct oral anticoagulants but is still in the developmental phase.

Antibodies, Monoclonal, Humanized - therapeutic use

Anticoagulants - adverse effects

Anticoagulants - therapeutic use

Antidotes - therapeutic use

Blood Coagulation Factors - therapeutic use

Blood Coagulation Tests

Hemorrhage - blood

Hemorrhage - chemically induced

Hemorrhage - therapy

Humans

International Normalized Ratio

Plasma

Protamines - therapeutic use

Details

Title: Subtitle: Reversal of Anticoagulation and Management of Bleeding in Patients on Anticoagulants
Creators: Prajwal Dhakal - Michigan State University
Supratik Rayamajhi - Michigan State University
Vivek Verma - University of Nebraska Medical Center
Krishna Gundabolu - University of Nebraska Medical Center
Vijaya R Bhatt - University of Nebraska Medical Center
Resource Type: Journal article
Publication Details: Clinical and applied thrombosis/hemostasis, Vol.23(5), pp.410-415
DOI: 10.1177/1076029616675970
PMID: 27789605
NLM abbreviation: Clin Appl Thromb Hemost
ISSN: 1076-0296
eISSN: 1938-2723
Language: English
Date published: 07/2017
Academic Unit: Hematology, Oncology, and Blood & Marrow Transplantation; Internal Medicine
Record Identifier: 9984360145302771

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