Emergent Reversal of Anticoagulants Flashcards
Reversal Agents
antiplatelet agents (platelet transfusions)
heparins (protamine)
vitamin K antagonist (warfarin)
- 3 and 4 factor PCC
-vitamin K
direct thrombin inhibitors
-idarucizumab (reversal of dabigatran)
-andexanet alfa (reverses apixaban or rivaroxaban)
emerging agent
- ciraparangtag (reversals UFH, LMWH, fondaparinux, dabigatran, FXa)
FFP
variable but near normal levels of coagulation factors, coagulation inhibitors, albumin, and immunoglobins
Cryoprecipiate
slowly thawing FFP leaves behind a cold-insoluble precipitate which contains fibrinogen, FVIII, vWF and FXIII
Factor concentrates
plasma derived and recombinant (jehovah’s witness)
Coagulation Factors in FFP
2, VII, VIIII, IX,X, XI
Coagulation Factors in PCC
concentrated coagulation factors
II, VII, IX, X, XII, protein C and Protein S
Cryoprecipitate
fibrinogen
von willebrand factor
Fresh Frozen Plasma
thawed FFP contains variable but near normal levels of procoagulant proteins, coagulation inhibitors, albumin, and immunoglobulins
Efficacy of FFP transfusions are assessed by
PT/INR, PTT, fibrinogen level adn platelet count, viscoelastic tests which take about 30-90 minutes
Slowly thawing FFP leaves behind a
cold-insoluble precipitate which contains fibrinogen, FVIII, vWF and FXIII
FFP: Fibrinogen content per vial or unit
Volume per vial or unit
0.5g/250ml per unit
Cryoprecipitate:
Fibrinogen content per vial or unit
Volume per vial or unit
0.3g/20ml per unit
Plasma-derived fibrinogen:
Fibrinogen content per vial or unit
Volume per vial or unit
0.9-1.3g/50ml per vial
Blood Product Compatibility and administration
Filter + warmer
PRBCS, FFP, Cryopreciptate
Platelet Administration
Platelets
Factor Concentrates
Plasma derived and recombinant
Plasma derived
Factor VIII, Factor IX, factor XIII riastap FEIBA profinine kcentra
riastap
fibrinogen concentrate factor I
FEIBA
factor eight inhibitor bypassing activity-mainly contains no activated II, IX, X and mainly activated VII along with heparin, AT and PROC &S
Profinine
factors 2,7 and 10
3 factor complex concentrate which was originally approved for treatment of patients with hemophilia B (factor IX deficiency)
not for warfarin or factor X reversal
kcentra
factors 2, 7, 9 and X
4 factor complex concentrate which is approved for reversal of vitamin K antagonist
contains anti-thrombotic proteins C and S and heparin 8-40 units in 500 unit vials in addition to factors 2, 7, 9 and 10
approved for treatment of adult patients with vitamin K antagonist with an INR >1.5 adn experiencing acute major bleeding
Recombinant
factor VIIa, Factor IX
Patient bleeding from warfarin will administer
kcentra
Riastap Human derived fibrinogen concentrate
fibrinogen concentrate is fractionated from blood and is stored at room temperature for up to 30 month
can be quickly reconstituted and administered IV with no thawing or blood type machine required
Fibrinogen concentrate is standardized in each vial