How Do I Reverse Oral and Parenteral Anticoagulants

作者: Jürgen Koscielny , Edita Rutkauskaite , Christoph Sucker , Christian von Heymann

DOI: 10.1055/A-1113-0557

关键词:

摘要: An understanding of reversal strategies alone is important to safely and effectively care for patients in cases bleeding or invasive procedures. The recent diversification the number licensed anticoagulants makes an drug-specific essential. Intravenous oral vitamin K can reverse effect antagonists (VKAs) within 12 48 hours indicated any international normalized ratio >10 4.5 10 with additional risk factors bleeding. Furthermore, administration prothrombin complex concentrate (PCC) may be necessary major related VKA. Protamine (chloride sulfate) fully reverses unfractionated heparin partially low-molecular-weight heparin. Idarucizumab has been approved dabigatran reversal, whereas andexanet alfa some factor Xa inhibitors (apixaban, rivaroxaban). PCC seems enhance haemostatic potential FXa-inhibitors. So far, there are promising but only limited data on efficacy this approach available. Each strategy needs adequate management beyond hemostatic treatment (volume replacement, stabilization homeostasis, e.g., pH temperature, resumption anticoagulation after successful bleeding, etc.) that crucial acute bleedings, urgent high-risk surgery, thrombolytic therapies thrombectomies as well overdosing anticoagulants.

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