Assessing Bleeding Risk in Patients With Intentional Overdoses of Novel Antiplatelet and Anticoagulant Medications

Levine, M.D. Norman; Beuhler, Michael C.; Pizon, Anthony F.; Cantrel, F. Lee; Spyres, Meghan B.; LoVecchio, Frank; Skolnik, Aaron B.; Brooks, Daniel E.

doi:10.1016/j.annemergmed.2017.08.046

Cited by 16 publications

(14 citation statements)

References 22 publications

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“…Most patients with acute DOAC overdose, however, do not present with bleeding. In one study of 52 patients with acute dabigatran, rivaroxaban, or apixaban over‐dosage, 7 (13%) presented with major bleeding, 2 presented with minor bleeding, and 43 were asymptomatic . Management of such patients in published case reports is highly variable.…”

Section: Guidancementioning

confidence: 99%

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Reversal of direct oral anticoagulants: Guidance from the Anticoagulation Forum

Cuker

Burnett

Triller³

et al. 2019

American J Hematol

258

263

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Two specific reversal agents for direct oral anticoagulants (DOACs) have been approved in the United States: idarucizumab for dabigatran reversal and andexanet alfa for apixaban and rivaroxaban reversal. Non‐specific prohemostatic agents such as prothrombin complex concentrate (PCC) and activated PCC have also been used for DOAC reversal. The goal of this document is to provide comprehensive guidance from the Anticoagulation Forum, a North American organization of anticoagulation providers, regarding use of DOAC reversal agents. We discuss indications for reversal, provide guidance on how the individual reversal agents should be administered, and offer suggestions for stewardship at the health system level.

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Section: Guidancementioning

confidence: 99%

“…Cases involving apixaban and dabigatran have likewise been conservatively managed with success . While blood products and idarucizumab have also been administered safely in some overdose cases, their impact on clinical outcomes is unclear …”

Section: Guidancementioning

confidence: 99%

Reversal of direct oral anticoagulants: Guidance from the Anticoagulation Forum

Cuker

Burnett

Triller³

et al. 2019

American J Hematol

258

263

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“…We conducted a literature search to identify similar cases, and the characteristics of the patients, along with the treatment, are shown in Table 1 . 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 …”

Section: Discussionmentioning

confidence: 99%

Conservative management of massive rivaroxaban overdose: A case report and literature review

Ghodsi

Etemad

Dadpour

et al. 2021

Clinical Case Reports

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“…However, studies have found that antiplatelet drugs are not suitable for drug absorption and can cause gastrointestinal irritation and bleeding [ 11 – 13 ]. A survey found that 7–29% of patients taking statins developed myositis [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

Acupuncture treatment for carotid atherosclerotic plaques: study protocol for a pilot randomized, single blinded, controlled clinical trial

Zhou

Zhao

Meng

et al. 2020

Trials

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Background Carotid atherosclerosis disease (CAD) is generally associated with the occurrence of cardiovascular and cerebrovascular accidents. However, CAD has not been taken seriously enough in the clinic, which, coupled with the single treatment and prevention of CAD, has led to a generally low level of patient compliance. Therefore, acupuncture is expected to be a safe and effective therapy that can be maintained in the long term for patients with CAD. The study objective is to evaluate the efficiency and reliability of acupuncture to relieve CAD and provide a new therapeutic idea for the clinical treatment of CAD. Methods This is a three-arm randomized clinical trial in China. Three groups (TA, SA, and MC) will be randomly allocated at a 1:1:1 ratio. The study will enrol 105 cervical atherosclerosis plaque patients in total on a voluntary basis, with 35 patients in each group. The treatment will last for 12 weeks, with two treatments per week for twenty-four treatments in total. Results Two 3D ultrasound indicators will be measured as the primary outcomes: the total plaque volume (PV) of the carotid artery on each side and the grey-scale median (GSM). The secondary outcomes will include intima-media thickness (IMT), lipid levels, apolipoprotein A-IV level, platelet count (PLT), fibrinogen (FIB), and platelet aggregation rate (PAR). All the outcomes will be assessed before treatment, after treatment, and after a 12-week follow-up period. This study will utilize per-protocol (PP) and intention-to-treat (ITT) analysis principles. Conclusions This trial is to evaluate the efficacy and reliability of acupuncture in relieving carotid atherosclerotic plaques by establishing acupuncture (TA), sham acupuncture (SA), and medication (MC) groups. Ethics and dissemination This study was approved by the Institutional Ethics Committee of Guangdong Provincial Hospital of Traditional Chinese Medicine (no. YF2018-107-01). All data and findings will be provided by the principal investigator via email. Trial registration ChiCTR, ChiCTR1800019259. Registered on 1 November 2018—retrospectively registered, http://www.chictr.org.cn/index.aspx

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Assessing Bleeding Risk in Patients With Intentional Overdoses of Novel Antiplatelet and Anticoagulant Medications

Cited by 16 publications

References 22 publications

Reversal of direct oral anticoagulants: Guidance from the Anticoagulation Forum

Reversal of direct oral anticoagulants: Guidance from the Anticoagulation Forum

Conservative management of massive rivaroxaban overdose: A case report and literature review

Acupuncture treatment for carotid atherosclerotic plaques: study protocol for a pilot randomized, single blinded, controlled clinical trial

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