Role of agents for reversing the effects of target-specific oral anticoagulants

Riley, Tanya R.; Gauthier-Lewis, Mary L.; Sanchez, Chelsea K.; Douglas, Janine

doi:10.2146/ajhp150810

Cited by 14 publications

(12 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…There were fewer patients not on anticoagulants who walked with an assistive device (27%) than and reversed patients (41%), p ¼ 0.01. Patients not on anticoagulants were taking a median [IQR] of 5 [2,8] medications, whereas those not reversed were taking 6 [4,9] and those reversed were taking 7 [5,10]. There were a higher proportion of reversed patients (23%) who had congestive heart failure (CHF) than patients not on anticoagulants (8%), p < 0.001.…”

Section: Resultsmentioning

confidence: 99%

“… 2 , 3 , 4 Many geriatric patients take anticoagulants, requiring reversal in four to six percent of patients often for an urgent invasive procedure, surgery for patients on pre-injury anticoagulants may increase the risk for blood loss and blood transfusions. 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 However, anticoagulation reversal may increase the time to surgery. Surgery within 24 h of admission has been associated with reduced morbidity, hospital length of stay (HLOS), and complication rates.…”

Section: Introductionmentioning

confidence: 99%

“… 10 , 18 Still, DOACs (dabigatran, rivaroxaban, apixaban, and edoxaban) are preferred to warfarin because they have fewer interactions, a wider therapeutic window, no need for monitoring, and a lower risk for bleeding. 8 , 9 , 10 , 11 “Non-specific” reversal agents: fresh frozen plasma (FFP), prothrombin complex concentrates (PCC), activated PCC (aPCC) and recombinant activated factor VIIa have been used to reverse DOACs or accelerate warfarin reversal. 9 , 10 , 16 Another option is to “wait and watch” for the anticoagulation effect to dissipate naturally.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Is anticoagulation reversal necessary prior to surgical treatment of geriatric hip fractures?

Meinig

Jarvis²,

Orlando³

et al. 2020

Journal of Clinical Orthopaedics and Trauma

View full text Add to dashboard Cite

Objective: Hip fracture surgery in geriatric patients on anticoagulants may increase the risk for blood loss. Anticoagulation reversal may lower these risks; however, data on blood loss and transfusions are limited. The study purpose was to compare outcomes between hip fracture patients 1) not on anticoagulants 2) whose anticoagulants were reversed, and 3) whose anticoagulants were not reversed. Methods: This four-year retrospective cohort study at six Level 1 Trauma Centers enrolled geriatric patients (!65) with isolated hip fractures. The primary outcome was total hospital blood loss (ml). Secondary outcomes: hospital length of stay (HLOS) and volume of packed red blood cells (pRBC) transfusions (ml). Statistical analyses included: Fisher's, chi-squared, Kruskal-Wallis, linear mixed-effect and logistic regression. Bonferroni adjusted alpha ¼ 0.025. Results: Of the 459 patients, 189 (41%) were not on anticoagulants, 186 (41%) were reversed, and 84 (18%) were not reversed. The LS mean (SE) blood loss was 134 ml (12) for not reversed patients and 159 (17) for reversed patients; no significant difference compared to those not on anticoagulants [138 (12)], pdiff ¼ 0.14 and 0.83, respectively. The LS mean (SE) HLOS was significantly longer for the reversed patients, 7.7 (0.4) days, when compared to those not on anticoagulants, 6.8 (0.4), p ¼ 0.02, and when compared to those not reversed, 6.3 (0.6), p ¼ 0.01. There was no significant difference in pRBC transfusions. Conclusion: Not reversing anticoagulants for geriatric hip fractures was not associated with increased volume of blood loss or transfusions when compared to those reversed. Delayed surgery for anticoagulant reversal may be unnecessary and contributing to an increased HLOS.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Is anticoagulation reversal necessary prior to surgical treatment of geriatric hip fractures?

Meinig

Jarvis²,

Orlando³

et al. 2020

Journal of Clinical Orthopaedics and Trauma

View full text Add to dashboard Cite

show abstract

“…In addition, we recommend discontinuing warfarin 5 days prior to the procedure and monitoring the INR to ensure that it has normalised. In the event that urgent reversal is needed, we recommend normalising the coagulopathy with use of reversal agents [31][32][33][34][35] if clinically possible before the procedure. However, clinical discretion, urgency of the procedure and benefit versus risk should be taken into account before the decision is made to proceed with or forgo these procedures.…”

Section: Resultsmentioning

confidence: 99%

Management of anticoagulant and antiplatelet therapy in patients undergoing interventional pulmonary procedures

2017

View full text Add to dashboard Cite

There has been great progress in antithrombotic therapy over the past several years. Its use has increased with the advent of novel anticoagulants, as these medications do not require frequent blood tests for monitoring. Antithrombotic therapy is aimed at reducing the risk of thromboembolic events in patients with atrial fibrillation, coronary artery disease, deep vein thrombosis, valvular heart disease and pulmonary embolism. These patients are often critically ill and frequently undergo urgent interventions requiring discontinuation of anticoagulant or antiplatelet therapy which can increase the risk of thrombosis; however, continuing these agents can lead to increased risk of haemorrhage.The purpose of this article is to summarise the literature surrounding the safety of using antiplatelet and anticoagulant therapies in patients undergoing interventional pulmonary procedures.

show abstract

“…Az idarucizumab (Praxbind) egy monoklonális antitest, amelyhez a dabigatran irreverzibilisen, 350-szer nagyobb affinitással kötődik, mint a trombinhoz, majd az 1:1 arányú antitest/dabigatran komplex a vesén keresztül ürül ki a szervezetből. Az idarucizumab gyorsan és hatékonyan képes felfüggeszteni a dabigatran hatását vérzés esetén, vagy nagy vérzésveszéllyel járó invazív beavatkozás előtt [16,26].…”

Section: Az Egyes Noac-készítmények Részletes Jellemzése Dabigatran (unclassified

Az új orális antikoagulánsokkal történő kezelés laboratóriumi vonatkozásai

et al. 2017

View full text Add to dashboard Cite

The introduction of novel oral anticoagulants (NOAC) have long been expected drugs and they quickly became used widespread as their clinical effectiveness was as good as, or even better than the previously used only oral anticoagulant drug, the coumarins. Thus, the direct thrombin inhibitor dabigatran and the activated factor X inhibitors (rivaroxaban, apixaban, edoxaban) have become the part of daily therapeutic practice. Their permeation was facilitated by the guideline which suggested that no laboratory monitoring was required during NOAC treatment and this was very convenient for both patients and doctors. The clinical experience obtained in the past years, however have proved that the 'one size fits all' view is oversimplified and there are numerous situations when the determination NOAC levels is unavoidable or highly recommended. This review discusses the laboratory aspects of NOAC treatment, primarily summarizing their effect on the screening tests and special assays of hemostasis and we also describe the correct methods to determine their plasma concentrations. Orv Hetil. 2017; 158(49): 1930-1945.

show abstract

Role of agents for reversing the effects of target-specific oral anticoagulants

Cited by 14 publications

References 21 publications

Is anticoagulation reversal necessary prior to surgical treatment of geriatric hip fractures?

Is anticoagulation reversal necessary prior to surgical treatment of geriatric hip fractures?

Management of anticoagulant and antiplatelet therapy in patients undergoing interventional pulmonary procedures

Az új orális antikoagulánsokkal történő kezelés laboratóriumi vonatkozásai

Contact Info

Product

Resources

About