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3.10.3 - Anticoagulation, Bridging and Emergency Reversal in Intensive Care

from Section 3.10 - Haematological and Oncological Disorders

Published online by Cambridge University Press:  27 July 2023

Ned Gilbert-Kawai
Affiliation:
The Royal Liverpool Hospital
Debashish Dutta
Affiliation:
Princess Alexandra Hospital NHS Trust, Harlow
Carl Waldmann
Affiliation:
Royal Berkshire Hospital, Reading
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Summary

Key Learning Points

  1. 1. Urgent warfarin reversal is either with vitamin K or, in select emergency circumstances, with a 4-factor prothrombin complex concentrate.

  2. 2. Direct oral anticoagulants (DOACs) are being used increasingly, and their therapeutic effect is not excluded by normal coagulation screening tests.

  3. 3. There are specific reversal agents for dabigatran and factor Xa inhibitor anticoagulants.

  4. 4. If urgent heparin reversal is needed, in select cases, protamine sulphate can be considered after discussion with haematology, although low-molecular weight heparin will only be partially reversed.

  5. 5. Inferior vena cava filters are only recommended in select circumstances.

Type
Chapter
Information
Intensive Care Medicine
The Essential Guide
, pp. 333 - 335
Publisher: Cambridge University Press
Print publication year: 2021

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References

References and Further Reading

Keeling, D, Tait, RC, Watson, H; British Committee of Standards for Haematology. Peri-operative management of anticoagulation and antiplatelet therapy. Br J Haematol 2016;175:602–13.CrossRefGoogle ScholarPubMed
Kitchen, S, Gray, E, Mackie, I, Baglin, T, Makris, M; BCSH Committee. Measurement of non-coumarin anticoagulants and their effects on tests of haemostasis: guidance from the British Committee for Standards in Haematology. Br J Haematol 2014;166:830–41.CrossRefGoogle ScholarPubMed
Makris, M, Van Veen, JJ, Tait, CR, Mumford, AD, Laffan, M; British Committee for Standards in Haematology. Guideline on the management of bleeding in patients on antithrombotic agents. Br J Haematol 2013;160:3546.CrossRefGoogle ScholarPubMed
Thachil, J, Hill, Q (eds). Haematology in Critical Care: A Practical Handbook. Chichester: John Wiley & Sons; 2014.CrossRefGoogle Scholar

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