ANTICOAGULANT REVERSAL

Question 1

MANAGEMENT

Answer 1

Warfarin with elevated INR:
Octaplex (PCC) 80mL (2000 U)
AND
10 mg Vit K IV, hold Warfarin

repeat INR.
Goal INR < 1.6
Plt goal > 100 k
DDVAP if uremic

Rivaroxaban / Apixaban / Edoxaban: Octaplex (PCC) 80mL (2000 U)
+/- 10 mg Vit K IV if elevated INR

Heparin:
Protamine Sulfate (time dependent dosing)
Heparin: 1 mg protamine/100 units heparin
Maximum dose is 50 mg.
Protamine dose requirement decreases as heparin is metabolized.
Low-molecular-weight heparins:
Last dose given within 8 hours: 1 mg protamine/1 mg of low-molecular-weight heparins
Second dose of 0.5 mg protamine/1 mg of low-molecular-weight heparins if bleeding continues
If last dose given between 8-12 hours prior: 0.5 mg protamine/1 mg of low-molecular-weight heparins
If >12 hours, a dose of protamine may not be required

Dabigatran:
idarucizumab 5 g IV
fXa: andexamet, TXA

Thrombocytopenia: platelet transfusion