Anticoagulants and antithrombotics in critical illness

2016 ◽  
Author(s):  
Vickie McDonald ◽  
Marie Scully
Keyword(s):  
Platelet Count ◽  
Critical Illness ◽  
Prothrombin Complex Concentrate ◽  
Oral Anticoagulants ◽  
Fresh Frozen Plasma ◽  
Heparin Therapy ◽  
Heparin Induced Thrombocytopenia ◽  
Routine Monitoring ◽  
Fresh Frozen ◽  
Frozen Plasma

Coagulation is best thought of using the cell-based model of coagulation. Patients commenced on heparin therapy should have their platelet count monitored early because of the risk of heparin-induced thrombocytopenia, which can occur on any type or dose of heparin. Emergency reversal of warfarin should be with prothrombin complex concentrate (containing factors II, VII, IX, and X) and not fresh frozen plasma. New oral anticoagulants have the advantage of predictable pharmacokinetics and do not require routine monitoring, but optimal reversal strategies for these agents are not clear. Thrombolytic agents lead to variable degrees of systemic lysis, which may cause haemorrhage, including intracerebral haemorrhage

Anticoagulation and Reversal Drugs

2018 ◽  
Author(s):  
Eelco F. M. Wijdicks ◽  
Sarah L. Clark
Keyword(s):  
Pulmonary Embolus ◽  
Prothrombin Complex Concentrate ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Fresh Frozen Plasma ◽  
Safety Issues ◽  
Fresh Frozen ◽  
Intravenous Vitamin ◽  
Frozen Plasma ◽  
Current Reversal

Management of anticoagulation, is a common practice. This chapter discusses best approaches, heparin choices, and safety issues. Anticoagulation is required in immobilized patients in the neurosciences intensive care unit to prevent deep venous thrombosis and the more consequential pulmonary embolus. There are very few strong indications for anticoagulation in ischemic stroke and exceptions are discussed. Reversal of anticoagulation is also needed in some patients and certainly in patients with recent significant trauma or spontaneous hemorrhages. Current reversal protocols require intravenous vitamin K, fresh-frozen plasma, and more often, prothrombin complex concentrate. Reversal of the effect of the direct oral anticoagulants is more difficult but options are discussed.

scholarly journals Effects of implementing rotational thromboelastometry in cardiac surgery: A retrospective cohort study

2021 ◽  
pp. 175045892095066
Author(s):  
Minna Kallioinen ◽  
Mika Valtonen ◽  
Marko Peltoniemi ◽  
Ville-Veikko Hynninen ◽  
Tuukka Saarikoski ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Prothrombin Complex Concentrate ◽  
Fresh Frozen Plasma ◽  
Blood Products ◽  
Rotational Thromboelastometry ◽  
Number Of Patients ◽  
Fresh Frozen ◽  
The Mean ◽  
To Receive ◽  
Frozen Plasma

Since 2013, rotational thromboelastometry has been available in our hospital to assess coagulopathy. The aim of the study was to retrospectively evaluate the effect of thromboelastometry testing in cardiac surgery patients. Altogether 177 patients from 2012 and 177 patients from 2014 were included. In 2014, the thromboelastometry testing was performed on 56 patients. The mean blood drainage volume decreased and the number of patients receiving platelets decreased between 2012 and 2014. In addition, the use of fresh frozen plasma units decreased, and the use of prothrombin complex concentrate increased in 2014. When studied separately, the patients with a thromboelastometry testing received platelets, fresh frozen plasma, fibrinogen and prothrombin complex concentrate more often, but smaller amounts of red blood cells. In conclusion, after implementing the thromboelastometry testing to the practice, the blood products were given more cautiously overall. The use of thromboelastometry testing was associated with increased possibility to receive coagulation product transfusions. However, it appears that thromboelastometry testing was mostly used to assist in management of major bleeding.

Direct (new) oral anticoagulants (DOACs): Drawbacks, bleeding and reversal

2021 ◽  
Vol 19 ◽  
Author(s):  
Ozgur Karcioglu ◽  
Sehmus Zengin ◽  
Bilgen Ozkaya ◽  
Eylem Ersan ◽  
Sarper Yilmaz ◽  
...  
Keyword(s):  
Oral Anticoagulants ◽  
Fresh Frozen Plasma ◽  
New Oral Anticoagulants ◽  
Coagulation Cascade ◽  
Thrombin Inhibitor ◽  
Severe Bleeding ◽  
Prothrombin Complex Concentrates ◽  
Clinical Scenarios ◽  
Fresh Frozen ◽  
Frozen Plasma

Background and Objective: Direct (new) Oral Anticoagulants (DOACs) have emerged as a contemporary and promising option in the treatment of thromboses and VTE, while protecting the coagulation cascade against untoward bleeding events. They are used in the management and prophylaxis of Venous Thromboembolism (VTE) and other thrombotic diseases. The most prominent complication of these agents is bleeding. These agents have similar or lower rates of major intracranial hemorrhages, while they had a higher risk of major gastrointestinal bleeding when compared to warfarin. This manuscript is aimed to revise and update the literature findings to outline the side effects of DOACs in various clinical scenarios. Methods: A narrative review of currently published studies was performed. Online database searches were performed for clinical trials published before July 2021, on the efficacy and adverse effects attributed to the anticoagulant treatment, especially DOACs. A literature search via electronic databases was carried out, beginning with the usage of the agents in the Western Languages papers. The search terms initially included direct (new) oral anticoagulants, dabigatran, rivaroxaban, apixaban, edoxaban, idarucizumab, andexanet, prothrombin complex concentrates, and fresh frozen plasma. Papers were examined for methodological soundness before being included. Results: Severe bleeding episodes require aggressive interventions for successful management. Therefore, bleeding should be evaluated in special regard to the location and rate of hemorrhage, and total volume of blood loss. Patient's age, weight and organ dysfunctions (e.g., kidney/liver failure or chronic respiratory diseases) directly affect the clinical course of overdose. Conclusion: Management recommendations for hemorrhage associated with DOAC use vary, depending on the class of the culprit agent (direct thrombin inhibitor vs. FXa inhibitor), the clinical status of the patient (mild/ moderate vs. severe/life-threatening), and capabilities of the institution. Specific reversal agents (i.e., idarucizumab and andexanet alfa) can be used if available, while prothrombin complex concentrates, fresh frozen plasma and/ or tranexamic acid can also be employed as nonspecific replacement agents in the management of DOAC-related bleeding diathesis.

scholarly journals An Exploratory Cohort Study Comparing Prothrombin Complex Concentrate and Fresh Frozen Plasma for the Treatment of Coagulopathy After Complex Cardiac Surgery

2015 ◽  
Vol 121 (1) ◽  
pp. 26-33 ◽  
Author(s):  
Erik Ortmann ◽  
Martin W. Besser ◽  
Linda D. Sharples ◽  
Caroline Gerrard ◽  
Marius Berman ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Cohort Study ◽  
Prothrombin Complex Concentrate ◽  
Fresh Frozen Plasma ◽  
Fresh Frozen ◽  
Frozen Plasma

scholarly journals The Effect of Adjunctive Fresh Frozen Plasma Administration on Coagulation Parameters and Survival in a Canine Model of Antivenom-treated Brown Snake Envenoming

2005 ◽  
Vol 33 (1) ◽  
pp. 36-40 ◽  
Author(s):  
G. A. Jelinek ◽  
A. Smith ◽  
D. Lynch ◽  
A. Celenza ◽  
I. Irving ◽  
...  
Keyword(s):  
Platelet Count ◽  
Early Death ◽  
Canine Model ◽  
Fresh Frozen Plasma ◽  
Dose Administration ◽  
Fresh Frozen ◽  
Venom Dose ◽  
Clotting Disorder ◽  
Frozen Plasma

This study aimed to assess the effects of dugite envenoming on blood coagulation and platelet count in a canine model, and the efficacy of fresh frozen plasma (FFP) in reversing the clotting disorder after both adequate and inadequate venom neutralization. Following initial dosing and administration studies, an intravenous venom dose of 1μg/kg was administered to eleven dogs. This was followed 30 minutes later by antivenom in either adequate or inadequate doses. A further 30 minutes later, the animals were given either two units of their own FFP or saline. Fibrinogen, aPTT and platelet levels were monitored for eight hours. Of the six study dogs given antivenom plus FFP, two died at around 60 to 90 minutes post envenoming, at the end of the FFP infusions, and all but one of the survivors had persistent afibrinogenaemia. Of the five study dogs given antivenom and no FFP, all but one had return of detectable fibrinogen at eight hours after envenoming. The platelet count fell in all animals with recovery independent of antivenom dose, administration of FFP, or regeneration of fibrinogen. Post mortem examinations of dogs that died during dosage and administration studies showed massive intracardiac clots. We conclude that early death from Brown Snake envenoming may be due to massive intravascular clotting. FFP administration was associated with persistent afibrinogenaemia regardless of antivenom dose. In the absence of any evidence for its efficacy, this study suggests that the role of FFP after Brown Snake envenoming should be reconsidered.

Comparative Analysis of Prothrombin Complex Concentrate and Fresh Frozen Plasma in Coronary Surgery

2019 ◽  
Vol 28 (12) ◽  
pp. 1881-1887 ◽  
Author(s):  
Fausto Biancari ◽  
Vito G. Ruggieri ◽  
Andrea Perrotti ◽  
Riccardo Gherli ◽  
Till Demal ◽  
...  
Keyword(s):  
Comparative Analysis ◽  
Prothrombin Complex Concentrate ◽  
Fresh Frozen Plasma ◽  
Coronary Surgery ◽  
Fresh Frozen ◽  
Frozen Plasma

Primary Plasma Therapy For Thrombotic Thrombocytopenic Purpura

1981 ◽  
Author(s):  
D C Case
Keyword(s):  
Platelet Count ◽  
Blood Cells ◽  
Reticulocyte Count ◽  
Fresh Frozen Plasma ◽  
Red Cell ◽  
Peripheral Smear ◽  
Plasma Therapy ◽  
Packed Red Blood Cells ◽  
Fresh Frozen ◽  
Frozen Plasma

A 25-year old male was admitted for an episode of right sided headache and subsequent generalized seizure. On admission his temperature was 37.6°. He had generalized petechiae and conjunctival hemorrhages. Organomegaly and lymphadenopathy were absent. There was mild left sided weakness. The Hgb. was 6.9 g/dl., reticulocyte count 10%, WBC 11,500/mm3, and platelet count 10,000/mm3. There were numerous schistocytes on the peripheral smear; bone marrow revealed panhyperplasia. Coagulation studies were normal. The BUN was 30, and the creatinine 1.7 mg/dl. Plasma was positive for Hgb. CT scan was negative for gross intracranial bleeding. The diagnosis of T.T.P. was made. On admission, the patient received 10 units of platelets and 2 units of packed red blood cells. He did not require further red cell or platelet transfusions during the rest of his hospital course. He was then started on infusions of fresh-frozen plasma. He then received one unit every 3 hours for 6 days, one unit every 6 hours for 2 days, then one unit every 12 hours for 2 days and finally 1 unit daily for 5 days. The response was immediate. After the infusions were started, the hematologic parameters steadily improved. The patient’s hematuria rapidly improved. Further CNS symptoms did not appear. The patient’s Hgb. was 12 g/dl, and reticulocyte count was 2.5% by the 9th day. His platelet count was normal by the 4th day. The patient was discharged on the 15th day. Infusions of plasma were discontinued at the time of discharge. The patient required plasma therapy 4 weeks later for recurrent thrombocytopenia (50,000/mm3). The patient has remained normal for 9 months since therapy and further plasma has not been required. Primary plasma therapy for T.T.P. as sole treatment should be further studied.

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