3.10.3 - Anticoagulation, Bridging and Emergency Reversal in Intensive Care

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.