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Coagulopathy Reversal (Nonwarfarin Agents), Emergency Medicine

Susanne M. Hardy and John P. Lemos Reviewed 06/2017
 


Basics

Description

  • Patient on anticoagulant medications with minor, major, or clinically significant bleeding needing close monitoring +/− anticoagulant reversal

  • Anticoagulant medication

    • Indirect inhibit...

Diagnosis

  • Patient on anticoagulants with active bleeding

  • Indications for reversal

    • Serious or life-threatening bleeding

      • Trauma

      • GI bleeding

      • Intracerebral hemorrhage (ICH)

    • Procedural

Signs and Symptoms

History

  • Ty...

Treatment

Pre-Hospital

  • Pressure to hemorrhage (if possible)

  • 2 large-bore IVs

  • IV fluids

Initial Stabilization/Therapy

  • Same as pre-hospital

  • Hold anticoagulants

Ed Treatment/Procedures

  • Indirect inhibitors of thr...

Follow-Up

Disposition

Admission Criteria

  • Clinically significant bleeding

  • Utilization of reversal agents

Discharge Criteria

  • Insignificant bleeding that is controlled without the use of anticoagulant reversa...

Pearls and Pitfalls

  • Prophylactic heparin dosing does not typically confer an increased risk of major bleeding

  • LMWH is not always reversed with protamine—it is compound specific

  • If >12 hr have elapsed...

Additional Reading

  • Ageno  W, Gallus  AS, Wittkowsky  A, et al. Oral anticoagulant therapy: Antithrombotic therapy and prevention of thrombosis. Chest.  2012;141:e44S–e88S.

  • Tawil  I, Seder  D, Dupr...

Codes

ICD9

  • 286.6 Defibrination syndrome

  • 286.9 Other and unspecified coagulation defects

  • V58.61 Long-term (current) use of anticoagulants

  • 287.1 Qualitative platelet defects

ICD10

  • D65 Disseminated intravascul...

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