anticoagulation medications and reversal
- related: Hematology
- tags: #hemeonc
Medications and levels
- anticoagulation agents cascade and overview
- check factor 10a levels for DOACs, eliquis, apixaban, xarelto, rivaroxaban
- use prothrombin time to rule out dabigatran related bleeding
Reversal
- use cryoprecipitate to replete fibrinogen
- use andexanet alfa, 4 factor PCC, FEIBA for factor 10a reversal
- use idarucizumab Praxbind for dabigatran Pradaxa reversal
- fresh frozen plasma and cryoprecipitate have no role in factor 10a reversal
- use pcc for vitamin k antagonist and sometimes factor 10 reversal
- use idarucizumab Praxbind for dabigatran Pradaxa reversal
- use protamine sulfate for heparin reversal
- watch out for clots formation and tamponade when giving FEIBA
- use protamine gtt for heparin reversal due to continuous leak in obese patients?
- use vitamin K, FFP, PCC for Coumadin warfarin reversal
To organize
Cases
- Dabigatran: Pradaxa
- Idarucizumab: Praxbind
- Kcentra: PCC
- can dialyse but difficult if they are already having bleeding issues
10 reversal
- Rivaroxaban/apixaban instead
- Kcentra and FEIBA (factor 8 inhibitor bypassing agent, originally designed for hemophilia 8 patients. FEIBA has activated 2, 7, 9, 10)
- very expensive and need to be continuously infused. Very new
Links to this note
- Hematology
- check factor 10a levels for DOACs, eliquis, apixaban, xarelto, rivaroxaban
- fresh frozen plasma and cryoprecipitate have no role in factor 10a reversal
- use andexanet alfa, 4 factor PCC, FEIBA for factor 10a reversal
- use protamine sulfate for heparin reversal
- use prothrombin time to rule out dabigatran related bleeding
- use vitamin K, FFP, PCC for Coumadin warfarin reversal