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3.10.3 - Anticoagulation, Bridging and Emergency Reversal in Intensive Care
from Section 3.10 - Haematological and Oncological Disorders
- By Victoria Stables, Mari Thomas
Edited by Ned Gilbert-Kawai, The Royal Liverpool Hospital, Debashish Dutta, Princess Alexandra Hospital NHS Trust, Harlow, Carl Waldmann, Royal Berkshire Hospital, Reading
Book:

Intensive Care Medicine

Published online:

27 July 2023

Print publication:

01 December 2021, pp 333-335
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Summary

Key Learning Points
1. Urgent warfarin reversal is either with vitamin K or, in select emergency circumstances, with a 4-factor prothrombin complex concentrate.
2. Direct oral anticoagulants (DOACs) are being used increasingly, and their therapeutic effect is not excluded by normal coagulation screening tests.
3. There are specific reversal agents for dabigatran and factor Xa inhibitor anticoagulants.
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. Inferior vena cava filters are only recommended in select circumstances.