Anticoagulation and Related Emergencies Flashcards
Anticoagulation indications
Prevention of VTE
Management of ACS
How does fondaparinux work?
How is it administered?
Activates antithrombin III, which in turn potentiates the inhibition of coagulation factors Xa
Subcut
How are direct thrombin inhibitors administered?
Bivalirudin - IV
Dabigatran - oral
What scoring system is used to determine whether AF patients need anticoagulation?
CHAD-VASc
Which anticoagulants are given to reduce stroke risk in AF?
Apixaban
Dabigatran
Edoxaban
Rivaroxaban
Why might anticoagulation need to be stopped?
Bleeding
Emergency surgery
Which anticoagulants have a specific reversal available?
Vitamin K antagonists (e.g. warfarin):
- Prothrombin complex concentrate (PCC)
- Vitamin K (phytomenadione)
Heparins (unfractionated and low molecular weight):
- Protamine
Which anticoagulants cannot be reversed?
DOACs e.g. rivaroxaban, apixaban, dabigatran
Fondaparinux
Management of bleeding in an anti coagulated patient
Stop the anti-thrombotic drug
Document timing and amount of last drug dose and presence of pre-existing renal or
hepatic impairment
Assess source of bleeding
Request: FBC, PT, APTR, renal function, INR for warfarin
Correct haemodynamic compromise: IV fluids, red cell transfusion (aim Hb>7)
Apply mechanical pressure if possible
Reversal of bleeding on warfarin
PCC and Vitamin K
Reversal of bleeding on heparins
Protamine sulphate reverses UFH and partially reverses LMWH
Reversal of bleeding on fondaparinux
No specific antidote
Stop fondaparinux
General homeostatic measures
Reversal of bleeding on DOACs
No specific antidote
Stop drug
General haemostatic measures
Prothrombin complex considered in major/life-threatening bleeding (unlicensed)
Considerations in emergency surgery required for anti coagulated patients
What anticoagulant is the patient taking?
When was the last dose taken?
How urgent is the surgery? (6hrs, within 24hrs, after 24hrs)
What INR is considered safe to proceed in emergency surgery?
<1.5
