Emergent Reversal of Anticoagulants

Question 1

reversal for antiplatelets

Answer 1

platelet transfusion

Question 2

reversal for heparin

Answer 2

protamine

Question 3

reversal for warfarin

Answer 3

vitamin k, 3/4 factor PCCs

Question 4

reversal for direct thrombin inhibitors

Answer 4

Idarucizumab (for dabigatran)
Andexanet alfa (for apixaban and rivaroxaban)

Question 5

cryoprecipitate contains

Answer 5

fibrinogen, factor VIII, vWF, XIII

Question 6

FFP contains

Answer 6

coagulation factors, coagulation inhibitors, albumin, immunoglobulins

Question 7

which blood product cannot be given through a warmer?

Answer 7

platelets

Question 8

recombinant factor concentrates

Answer 8

factor VIIa, factor IX

Question 9

KCentra

Answer 9

factors II, VII, IX, X

Question 10

Profilnine

Answer 10

factors II, IX, X

Question 11

FEIBA

Answer 11

factors II, IX, X, VII

Question 12

Riastap

Answer 12

factor I

Question 13

Riastap considerations

Answer 13

can be stored for up to 30 months
can be quickly reconstituted and administered IV
fibrinogen concentrate is standardized in each vial (900-1300 mg per 50 mL vial)

Question 14

clinical uses for factor complex concentrates

Answer 14

reverses effects of significant vitamin k antagonism coagulopathy
emergent or urgent surgery
clotting deficiency

Question 15

when are factor complex concentrates contraindicated

Answer 15

DIC and HIT

Question 16

Profilnine

Answer 16

3-factor complex concentrate
hemophilia B (factor IX deficiency)
reserved for cardiac cases

Question 17

Kcentra

Answer 17

4 factor complex concentrate

reversal of vitamin k antagonists with INR >1.5

Question 18

Profilnine dosing

Answer 18

10-15 units/IBW kg, max 1,000 units

Question 19

which factor complex concentrate contains heparin?

Answer 19

kcentra

Question 20

recombinant activated factor VII (novoseven) uses

Answer 20

hemophilia A or B, congenital factor VII deficiency

“off label” : prevention and treatment of coagulopathy and major blood loss

Question 21

recombinant activated factor VII MOA

Answer 21

promotes hemostasis by activating the extrinsic pathway of the coagulation cascade
forms a complex with tissue factor at the site of injury activating factors IX and X leading to the formation of a plug

Question 22

factor VIIa dosing

Answer 22

90 mcg/kg IV bolus
reconstitute with sterile water
re-dose every 2 hours prn (half life 2 hours)
supplied in 1mg, 2mg, and 5 mg vials

Question 23

factor VII risks

Answer 23

thrombotic adverse event with DIC, athersclerotic disease, crush injury, septicemia

Question 24

what needs to be present in order for factor VII to be most effective?

Answer 24

adequate FFP, cryo and platelets because it depends on platelet and fibrinogen function