Management of the Anticoagulated Patient

Author: Melvin Carew / Editor: Steven A Bland / Reviewer: Reuben Cooper / Codes: CC2, O4 / Published: 19/10/2018

Catastrophic haemorrhage can occur in the anticoagulated patient. It is essential that emergency physicians know the major anticoagulants and the methods available to reverse their action.

After completing this session you will be able to:

  • Describe the presentations associated with haemorrhage in the anticoagulated patient.
  • Describe the initial management of haemorrhage in the anticoagulated patient.
  • Know the specific therapies used in the reversal of anticoagulation associated with heparin, warfarin and direct oral anti-coagulants.
START MODULE

References:

  1. Crowther MA, and Warkentin TE. Undergoing anticoagulant therapy: focus on new anticoagulant agents Bleeding risk and the management of bleeding complications in patients. Blood 2008;111(10):4871-4879.
  2. Leissinger CA, Blatt PM, Hoots WK, et al. Role of prothrombin complex concentrates in reversing warfarin anticoagulation: A review of the literature. Am J Hematol 2008;83:137-143.
  3. Ng HJ, Crowther MA. New anti-thrombotic agents: emphasis on hemorrhagic complications and their management. Semin Hematol 2006;43:S77-S83.
  4. Warkentin AE, Donadini MP, Spencer FA et al. Bleeding risk in randomized controlled trials comparing warfarin and aspirin: a systematic review and meta-analysis. J Thromb Haemost 2012:10:512520.
  5. Holbrook A, Schulman S, Witt DM et al. Evidence-based management of anticoagulant therapy: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012;141(2):e152S-84S.
  6. Crowther MA, Warkentin TE. Managing bleeding in anticoagulated patients with a focus on novel therapeutic agents. J Thromb Haemost 2009;7(1):107-110.
  7. Hirsh J, Bauer KA, Donati MB, et al.Parenteral Anticoagulants. Chest 2008;133:147S-50S.
  8. Baglin T, Barrowcliffe TW, Cohen A et al. Guidelines on the use and monitoring of heparin. Br J Haematol 2006;133(1):19-34.
  9. Makris M, Van Veen JJ, Tait CR et al. Guideline on the management of bleeding in patients on antithrombotic agents. British Committee for Standards in Haematology. Br J Haematol 2013;160(1):35-46.
  10. Siegal DM, Crowther MA. Acute management of bleeding in patients on novel oral anticoagulants. Eur Heart J 2013;34(7):489-498b.
  11. Warkentin TE, Crowther MA. Reversing anticoagulants both old and new. Can J Anaesth 2002;49:S11-S25.
  12. Weber JE, Jaggi FM, Pollack, CV. Anticoagulants, antiplatelet agents, and fibrinolytics. In: Tintinalli JE, Kelen GD, Stapczynski JS (eds). Emergency Medicine: A Comprehensive Study Guide. 6th ed. McGraw-Hill, 2004:1354-1360.
  13. Keeling D, Baglin T, Tait C et al. Guidelines on oral anticoagulation with warfarin fourth edition. British Committee for Standards in Haematology. Br J Haematol 2011;154(3):311-324.
  14. Vigue B. Bench-to-bedside review: Optimising emergency reversal of vitamin K antagonists in severe haemorrhage–from theory to practice. Crit Care 2009;13:209.
  15. Scottish Intercollegiate Guidelines Network 129 (2013). Antithrombotics: indications and management. Edinburgh: SIGN.
  16. Toxbase. View website
  17. Baglin T, Keeling D, Kitchen S. Effects on routine coagulation screens and assessment of anticoagulant intensity in patients taking oral dabigatran or rivaroxaban: Guidance from the British Committee for Standards in Haematology. Br J Haematol 2012;159(4):427-429.
  18. Alikhan R, Rayment R, Keeling D et al. The acute management of haemorrhage, surgery and overdose inpatients receiving dabigatran. Emerg Med J 2013 Feb 22. [Epub ahead of print]
  19. van Ryn J, Stangier J, Haertter S et al. Dabigatran etexilate-a novel, reversible, oral direct thrombin inhibitor: interpretation of coagulation assays and reversal of anticoagulant activity. Thromb Haemost 2010;103(6):1116-1127.
  20. Friedman RJ, Kurth A, Clemens A et al. Dabigatran etexilate and concomitant use of non-steroidal anti-inflammatory drugs or acetylsalicylic acid in patients undergoing total hip and total knee arthroplasty: No increased risk of bleeding. Thromb Haemost 2012;108(1):183-190.
  21. Stangier J, Rathgen K, Sthle H et al. Influence of renal impairment on the pharmacokinetics and pharmacodynamics of oral dabigatran etexilate: an open-label, parallel-group, single-centre study. Clin Pharmacokinet 2010;49(4):259-268.

Module Content

Expand All

Leave a Reply

BACK TO POST