ANTICOGULANT REVERSAL

Question 1

MDSO - Blood Products - Reversal of Warfarin

Indications:

Answer 1

Need Emergency Reversal ( ICH, Emergency Sx, Major Hemorrhage). AND. INR > 1.5

Question 2

MDSO - Blood Products - Reversal of Warfarin?

Tx? Dose ? Patch ?

Answer 2

PCC (Octaplex) - dose from 1000IU or 2000 IU depending on kg and INR, see chart - MP
10 mg Vit K - slow infusing 1mg/min (so over > 10 min) ** MP ** MUST be before or during PCC

• note PCC is considered a blood product and needs consent

Question 3

MDSO - Blood Products - DOAC Reversal

Indications

Answer 3

Life threatening bleed or Need for Emergency Sx

Question 4

MDSO - Blood Products - DOAC

Tx, dose, conditions and patch

Answer 4

All are MP

Pradaxa (Dabigatran) ——> Idarucizumab - 5 g (2 x 2.5 g vials) in 100 mL > 10 min bolus infusion - only in NS (PRAXABIND)

For Xarelto (Rivaroxaban) or Eliquis (Apixaban)
—-> 2000 IU of PCC (Octaplex), repeat at 1 hr if ongoing bleeding (is a blood product needs consent - - warfarin reversal has 1000 or 2000 units based on weight and INR)
—-> Also TXA 1 g > 10 min, then repeat in 1 hr (or ? Double up up front ? )