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Anticoagulation Reversal

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7 papers 0 to 25 followers Investigating the indications as well as clinical outcomes in Anticoagulation Reversal
W H Dzik
Oral factor Xa inhibitors are an attractive class of anticoagulants expected to have broad application. Rapid and reliable reversal of the anticoagulant effect is important for patients with bleeding complications or those in need of urgent reversal for procedures. While no specific reversal agent is yet available, multiple published clinical guidelines suggest that four-factor prothrombin complex concentrates (PCC) should be considered when urgent reversal is desired. This presentation updates prior reviews on this topic (Crit Care, 17, 2013, 230; Thromb Haemost, 111, 2014, 189; J Thromb Thrombolysis, 2015, 39, 395); and summarizes more recent evidence in human studies indicating that four-factor PCCs available in North America do not reverse oral factor Xa-inhibitor anticoagulants...
June 2015: Journal of Thrombosis and Haemostasis: JTH
Deborah M Siegal, Mark A Crowther
Novel oral anticoagulants that directly inhibit thrombin (dabigatran) or factor Xa (rivaroxaban, apixaban) are currently available for prevention of venous thromboembolism (VTE) after orthopaedic surgery, treatment of acute VTE, and prevention of arterial thromboembolism in non-valvular atrial fibrillation. These agents offer advantages over VKAs, including rapid onset, shorter half-lives, fewer drug interactions, and lack of need for routine monitoring. However, there are no established agents to reverse their anticoagulant effect...
February 2013: European Heart Journal
Deborah M Siegal, John T Curnutte, Stuart J Connolly, Genmin Lu, Pamela B Conley, Brian L Wiens, Vandana S Mathur, Janice Castillo, Michele D Bronson, Janet M Leeds, Florie A Mar, Alex Gold, Mark A Crowther
BACKGROUND: Bleeding is a complication of treatment with factor Xa inhibitors, but there are no specific agents for the reversal of the effects of these drugs. Andexanet is designed to reverse the anticoagulant effects of factor Xa inhibitors. METHODS: Healthy older volunteers were given 5 mg of apixaban twice daily or 20 mg of rivaroxaban daily. For each factor Xa inhibitor, a two-part randomized placebo-controlled study was conducted to evaluate andexanet administered as a bolus or as a bolus plus a 2-hour infusion...
December 17, 2015: New England Journal of Medicine
Armin Rashidi, H Raymond Tahhan
OBJECTIVE: To provide a practical formula for fresh frozen plasma (FFP) dosing for warfarin reversal. PATIENTS AND METHODS: We reviewed data on all adult patients who received a total of 7778 units of FFP for warfarin reversal at Sentara Norfolk General Hospital (Norfolk, VA) between April 1, 2009, and March 31, 2010. Patients with advanced liver disease, consumptive or dilutional coagulopathy, and administration of activated factor VII or prothrombin complex concentrate were excluded...
March 2013: Mayo Clinic Proceedings
A L Marshall, M Levine, M L Howell, Y Chang, E Riklin, B A Parry, R T Callahan, I Okechukwu, A M Ayres, B V Nahed, J N Goldstein
UNLABELLED: ESSENTIALS: Fresh frozen plasma (FFP) may be associated with a dose-based risk of pulmonary complications. Patients received FFP for warfarin reversal at a large academic hospital over a 3-year period. Almost 20% developed pulmonary complications, and the risk was highest after > 3 units of FFP. The risk of pulmonary complications remained significant in multivariable analysis. BACKGROUND: Fresh frozen plasma (FFP) is often administered to reverse warfarin anticoagulation...
February 2016: Journal of Thrombosis and Haemostasis: JTH
William E Dager
PURPOSE: To describe a process for prompt evaluation and management- including reversal of the effects of warfarin and target-specific oral anticoagulants-of patients with or at high risk for bleeding during oral anticoagulant therapy or when such therapy is interrupted for an urgent invasive procedure or surgery. SUMMARY: The use of pharmacologic interventions for anticoagulant reversal may depend on the measured level of anticoagulation, time since the last anticoagulant dose, target level of coagulation, reliability of laboratory tests of coagulation, severity of or risk for bleeding, the agents' mechanism of action and pharmacokinetics, and pharmacodynamics of the reversal agent...
May 15, 2013: American Journal of Health-system Pharmacy: AJHP
Dar Dowlatshahi, Kenneth S Butcher, Negar Asdaghi, Susan Nahirniak, Manya L Bernbaum, Antonio Giulivi, Jason K Wasserman, Man-Chiu Poon, Shelagh B Coutts
BACKGROUND AND PURPOSE: Anticoagulant-associated intracranial hemorrhage (aaICH) presents with larger hematoma volumes, higher risk of hematoma expansion, and worse outcome than spontaneous intracranial hemorrhage. Prothrombin complex concentrates (PCCs) are indicated for urgent reversal of anticoagulation after aaICH. Given the lack of randomized controlled trial evidence of efficacy, and the potential for thrombotic complications, we aimed to determine outcomes in patients with aaICH treated with PCC...
July 2012: Stroke; a Journal of Cerebral Circulation
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