Anticoagulation Reversal Guide and Reversal Agents

2019 ◽  
pp. 287-301
Author(s):  
Waleed Sabry ◽  
Caroline Hart ◽  
Hadi Goubran
Keyword(s):  
Anticoagulation Reversal ◽  
Reversal Agents

Factors associated with availability of anticoagulation reversal agents in rural and community emergency departments

2018 ◽  
Vol 75 (2) ◽  
pp. 72-77 ◽  
Author(s):  
Brett A. Faine ◽  
Julie Amendola ◽  
Jordan Homan ◽  
Azeemuddin Ahmed ◽  
Nicholas Mohr
Keyword(s):  
Emergency Departments ◽  
Anticoagulation Reversal ◽  
Reversal Agents ◽  
Factors Associated

scholarly journals Utilization of anti–factor Xa levels to guide reversal of oral factor Xa inhibitors in the emergency department

2021 ◽  
Author(s):  
Anne E Zepeski ◽  
Brett A Faine ◽  
Anna E Merrill ◽  
Grerk Sutamtewagul ◽  
Sharathkumar Bhagavathi
Keyword(s):  
Emergency Department ◽  
Anticoagulation Therapy ◽  
Factor Xa ◽  
Factor Xa Inhibitors ◽  
Prothrombin Complex Concentrates ◽  
Anticoagulation Reversal ◽  
Reversal Agents ◽  
Patient Disposition ◽  
Rule Out

Abstract Disclaimer In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Purpose Oral factor Xa inhibitors (FXaIs) are increasingly utilized for outpatient anticoagulation therapy; however, laboratory monitoring is not routinely used to assess the safety and efficacy of these agents. We aimed to evaluate the role of chromogenic anti–factor Xa (anti-Xa) assays in the emergency department (ED) in the setting of patients with an acute bleed or requiring emergent procedures. Methods A retrospective review was completed of anti-Xa levels obtained in the ED between June 1, 2019, and April 30, 2020. Data were collected to describe the clinical setting of anti-Xa level collection, oral FXaIs used before admission, administration of reversal agents, and patient disposition to further characterize the role of anti-Xa levels in the management of rivaroxaban and apixaban reversal. Results Thirty anti-Xa levels were included in the final analysis. The median time from sample collection to anti-Xa assay result was 45.9 minutes (interquartile range, 35.3-54.7 minutes). Eleven patients (37%) received anticoagulation reversal after their anti-Xa levels were determined. Anticoagulation reversal agents included either activated prothrombin complex concentrates (aPCCs) or prothrombin complex concentrates (PCCs). Anti-Xa levels were collected in 2 patients who had received PCCs before arrival at our ED. Of the patients with anti-Xa levels below 30 ng/mL, none received aPCCs or PCCs after their anti-Xa levels were determined. Anti-Xa assays were used to rule out the presence of FXaIs in 3 patients. Conclusion This study illustrates the novel role of anti-Xa levels in managing patients with an emergent need for reversal in the ED. The assay may be used to rule out the presence of oral FXaIs and avoid unnecessary administrations of anticoagulation reversal agents.

scholarly journals Clinical Course of Intracranial Bleeding in Patients Anticoagulated With Factor Xa inhibitors Without the Use of Specific Reversal Agents

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Emmalin Nelton ◽  
Georgios Maragkos ◽  
Sven Richter ◽  
Aristotelis Filippidis ◽  
Martina Stippler
Keyword(s):  
Clinical Outcomes ◽  
Factor Xa ◽  
Factor Xa Inhibitors ◽  
Secondary Outcome ◽  
Primary Study ◽  
Reversal Agent ◽  
Anticoagulation Reversal ◽  
Reversal Agents ◽  
Traumatic Intracranial Hemorrhage ◽  
History Of

Abstract INTRODUCTION Factor Xa inhibitors (FXI) are widely used anticoagulants but may cause or worsen acute major bleeding. Andexanet alfa, a novel anticoagulation reversal agent for FXI, was recently approved. Traumatic intracranial hemorrhage (tICH) presents a prime target for this drug, however questions remain regarding its effect on clinical outcomes compared to the natural history of tICH in the setting of FXI. This study aimed to evaluate the hematoma progression and clinical outcomes of patients on FXI who were not administered Andexanet reversal after tICH. METHODS An institutional traumatic brain injury (TBI) registry was queried between 2016 and 2019. Patients with recorded use of apixaban or rivaroxaban <18 h before injury were included. The primary study outcome was good hemostasis on repeated head computed tomography (CT), assessed according to the criteria of the ANNEXA-4 trial for Andexanet treatment. The secondary outcome was neurological worsening or surgical intervention during the hospitalization. RESULTS We identified 24 patients meeting the study inclusion criteria. Their mean (SD) age was 76.3 ± 13 yr and 10 (42%) were female. On admission CT, 15 patients had SDH, 6 had traumatic IPH, and 3 had SAH. All patients had their FXI therapy discontinued immediately after injury. Anticoagulation reversal was attempted in 16 patients, most commonly using prothrombin complex concentrate (PCC). Out of the 24 patients, 19 (79%) were adjudicated as having excellent or good hemostasis. A total of 23 (96%) patients remained neurologically stable throughout admission. CONCLUSION Our results indicate that in patients on FXI with complicated mild TBI it can be reasonably safe not to administer specific anticoagulation reversal. Hemostatic and clinical outcomes in our cohort were largely similar to those reported after Andexanet administration. Further research is necessary to determine if administration of Andexanet improves clinical outcomes.

Muscle Relaxants and Reversal Agents

1991 ◽  
Vol 3 (1) ◽  
pp. 151-158 ◽  
Author(s):  
Andrew D. Van Sickel ◽  
Karen Spadaccia
Keyword(s):  
Muscle Relaxants ◽  
Reversal Agents

Perioperative Management of Patients Receiving New Anticoagulants

2019 ◽  
Vol 25 (19) ◽  
pp. 2149-2157 ◽  
Author(s):  
Massimo Lamperti ◽  
Andrey Khozenko ◽  
Arun Kumar
Keyword(s):  
Vitamin K ◽  
Elective Surgery ◽  
Vitamin K Antagonists ◽  
Oral Anticoagulants ◽  
Oral Intake ◽  
Bleeding Risk ◽  
Dietary Vitamin ◽  
Reversal Agent ◽  
Onset Of Action ◽  
Reversal Agents

There is an increased use of oral anticoagulants for the prevention of venous and arterial thrombosis. Vitamin-K antagonists have been used for decades as the main oral anticoagulants but they have the draback a complex therapeutic management, slow onset of action and by a different oral intake caused by dietary vitamin K intake. New non-vitamin K antagonist oral anticoagulants (NOACs) have been developed to overcome the limitations of warfarin. Their management is easier as it requires a fixed daily dose without coagulation monitoring. Although their therapeutic profile is safe, proper attention should be paid in case of unexpected need for the reversal of their coagulation effect and in case a patient needs to have a scheduled surgery. For non-acute cardiac surgery, discontinuation of NOACs should start at least 48 hours prior surgery. Intracranial bleedings associated with NOACs are less dangerous comparing to those warfarin-induced. NOACs need to be stopped ≥24 hours in case of elective surgery for low bleeding-risk procedures and ≥48 hours for high bleeding-risk surgery in patients with normal renal function and 72 hours in case of reduced CrCl < 80. The therapy with NOACs should be resumed from 48 to 72 hours after the procedure depending on the perceived bleeding, type of surgery and thrombotic risks. There are some available NOAC reversal agents acting within 5 to 20 minutes. In case of lack of reversal agent, adequate diuresis, renal replacement therapy and activated charcoal in case of recent ingestion should be considered.

A Review on the Use of Reversal Agents of Direct Oral Anticogulant Drugs in Case of Gastrointestinal Bleeding

2020 ◽  
Vol 15 ◽  
Author(s):  
Veronica Ojetti ◽  
Angela Saviano ◽  
Mattia Brigida ◽  
Luisa Saviano ◽  
Alessio Migneco ◽  
...  
Keyword(s):  
Gastrointestinal Bleeding ◽  
Major Bleeding ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Medical Emergency ◽  
Management Approach ◽  
Emergency Setting ◽  
Reversal Agents ◽  
Life Threatening ◽  
Andexanet Alfa

Background : Major bleeding is a life-threatening condition and a medical emergency with high mortality risk. It is often the complication of anticoagulant’s intake. Anticoagulants are commonly used for the prevention and the treatment of thrombotic events. The standard therapy with vitamin K antagonist (warfarin) has been frequently replaced by direct oral anticoagulants (DOACs). The latter agents (rivaroxaban, apixaban, edoxaban, dabigatran, betrixaban) showed a better efficacy and safety compared to standard warfarin treatment and they are recommended for the reduction of ischemic stroke. Literature data reported a high risk of gastrointestinal bleeding with DOACs, in particular with dabigatran and rivaroxaban. In case of life-threatening gastrointestinal bleeding, these patients could benefit from the use of reversal agents. Methods: We performed an electronic search on PUBMED of the literature concerning reversal agents for DOACs and gastrointestinal bleeding in the Emergency Department from 2004 to 2020. AIM: This review summarizes the current evidences about three reversal agents idarucizumab, andexanet alfa and ciraparantag, and the use of the first two in the emergency setting in patients with an active major bleeding or who need urgent surgery to offer physicians indications for a better management approach in order to increase patient’s safety. Conclusion: Although these agents have been marketed for five years (idarucizumab) and two years (andexanet alfa) respectively, and despite guidelines considering antidotes as first-line agents in treating life-threatening hemorrhage when available, these antidotes seem to gain access very slowly in the clinical practice. Cost, logistical aspects and need for plasma level determination of DOAC for an accurate therapeutic use probably have an impact on this phenomenon.. An expert multidisciplinary bleeding team should be established so as to implement international guidelines based on local resources and organization.

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