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Guidance on the emergent reversal of oral thrombin and factor Xa inhibitors
Author(s) -
Kaatz Scott,
Kouides Peter A.,
Garcia David A.,
Spyropolous Alex C.,
Crowther Mark,
Douketis Jim D.,
Chan Anthony K. C.,
James Andra,
Moll Stephan,
Ortel Thomas L.,
Van Cott Elizabeth M.,
Ansell Jack
Publication year - 2012
Publication title -
american journal of hematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.456
H-Index - 105
eISSN - 1096-8652
pISSN - 0361-8609
DOI - 10.1002/ajh.23202
Subject(s) - dabigatran , rivaroxaban , medicine , apixaban , prothrombin complex concentrate , intensive care medicine , warfarin , drug , hemostasis , antidote , activated charcoal , expert opinion , pharmacology , atrial fibrillation , chemistry , organic chemistry , toxicity , adsorption
Abstract The new oral anticoagulants dabigatran, rivaroxaban and apixaban have advantages over warfarin which include no need for laboratory monitoring, less drug–drug interactions and less food‐drug interactions. However, there is no established antidote for patients who are bleeding or require emergent surgery and there is a paucity of evidence to guide the clinical care during these situations. Members of thrombosis and anticoagulation groups participating in the Thrombosis and Hemostasis Summit of North America formulated expert opinion guidance for reversing the anticoagulant effect of the new oral anticoagulants and suggest: routine supportive care, activated charcoal if drug ingestion was within a couple of hours, and hemodialysis if feasible for dabigatran. Also, the pros and cons of the possible use of four factor prothrombin complex concentrate are discussed. Am. J. Hematol. 2012. © 2012 Wiley Periodicals, Inc.