Emergent reversal of anticoagulants Flashcards
Antiplatelet agent reversal agent
platelet transfusion
Heparins reversal agent
protamine
Direct thrombin inhibitors reversal agents
idarucizumab (reverses dabigatran) andexanet alfa (reverses apixaban or rivaroxaban)
Vitamin K antagonists (warfarin) reversal agent
vitamin K
3 & 4 factor PCCs
Drug that reverses unfractionated heparin, low molecular weight heparin, fondaparinux, dabigatran, and FXa:
ciraparangtag
Cryoprecipitate contains
fibrinogen, FVIII, vWF, and factor FXIII
Factor concentrates include
plasma derived and recombinant
FFP contains
near normal levels of coagulation factors, coagulation inhibitors, albumin, and immunoglobulins
Large volumes of plasma transfusion are not well tolerated in patients with
limited cardiopulmonary reserve and can be associated with transfusion-associated circulatory overload and acute lung injury
The efficacy of transfusion is commonly assessed by
PT/INR, PTT, fibrinogen level, platelet count, and visoeleastic tests which average a turn around time of 60 minutes
Plasma derived fibrinogen
contains the most fibrinogen content per vial or unit as compared to FFP and cryo
These blood products go through the filter and the warmer
RBCs, FFP, and cryoprecipitate
These blood products go through the filter only (NO warmer)
platelets
Factor concentrates of recombinant include
Factor VIIa, Factor IX
Plasma derived factor concentrates include
factor VIII, vWF, Factor IX, Factor XIII
Kcentra contains factors
II, VII, IX, and X
Profilnine contains factors
II, IX, and X
FEIBA is
factor eight inhibitor bypassing activity and mainly contains non-activated II, IX, and X and mainly activated VII
Riastap contains
fibrinogen concentrate (Factor I)
Riastap is convenient because
it can be stored at room temperature for up to 30 months
can be quickly reconstituted and administered IV with no thawing or blood-type matching required
fibrinogen concentrate is standardized in each vial
Factor complex concentrates are
a biological product of pooled human plasma with therapeutic concentrations of factors II, VII, IX, and X
includes 4 factor: Kcentra & 3 factor: Profilnine
Clinical uses of factor complex concentrates include
reverses the effects of significant vitamin K-antagonism coagulopathy
emergent or urgent surgery for someone on coumadin
clotting deficiency
Factor complex concentrates are contraindicated in
DIC & HIT
Profilnine is a
3 factor complex concentrate which was originally approved for treatment of patients with hemophilia B (factor IX deficency)
Profilnine is reserved mainly for
cardiac cases
NOT indicated for warfarin or factor Xa reversal
Kcentria is a
4 factor complex concentrate which is approved for reversal of vitamin K antagonists
Factor IX complex is also known as
Profilnine
Profilnine contains
concentrated factors of IX, II, X and low levels of factor VII
does not contain heparin and contains no preservatives
Profilnine dosing is
based on temporarily increasing the plasma level of factor IX
10-15 units/IBW kg; max dose of 1,000 units
KCentra contains
antithrombotic proteins C & S and heparin 8-40 units in 500-unit vials in addition to factors II, VII, IX, and X
KCentra is FDA approved for the treatment of
adult patients treated with vitamin K antagonists (i.e. warfarin) with an INR >1.5 and experiencing acute major bleeding
KCentra can help reverse
factor Xa inhibitors like Xarelto and Eliquis at higher doses
Recombinant activated factor VII is also known as
NovoSeven
Recombinant activated factor VII is a
form of blood factor VII
Recombinant activated factor VII is used for
hemophilia A (deficiency of VIII) or B (deficiency of IX), congenital factor VII deficiency mostly used for "off-label" use for the prevention and treatment of coagulopathy and major blood loss
Specific uses of recombinant activated factor VII include
postpartum hemorrhage, trauma, reversal of various anticoagulants, and high-risk cardiothoracic, spinal, transplant, or vascular surgery
rFVIIa can be associated with an increased risk of
thrombosis particularly in patients who do not have hemophilia
Recombinant activated factor VIi is
the activated form of factor VII, bypasses factors VIII and IX and causes coagulation without the need for factors VIII and IX
Novoseven promotes hemostasis by
activating the extrinsic pathway of the coagulation cascade
forms a complex with tissue factor at the site of injury and activates coagulation factors IX and X which leads to the formation of a hemostatic plug
Theoretically, the mechanism of recombinant activated factor VII
localizes the action of factor VIIa to the site of injury and avoids the complications of thrombosis occurring in other vascular beds
Factor VIIa got its start during
the Iraq war to treat wounded troups
Factor VIIa works on
2 pathways
at the site of tissue injury to combine with tissue factor to directly activate factor X and on the platelet surface
Factor VIIa dosing includes:
20 mcg/kg to over 200 mcg/kg
re-dose can be every 2 hours as clinically indicated
Risks associated with factor VII include:
risk of thrombotic adverse events- DIC, advanced atherosclerotic disease, crush injury, septicemia, or concomitant tx prothrombin complex concentrates increase risk
Factor VII will not stop
surgical hemorrhage; it is a temporizing agent
Factor VII should not be given instead of
other blood products; need adequate FFP, Cryo, and platelets to be present for full effect (the mechanism of action depends on platelet and fibrinogen function
Factor Complex concentrates provide faster correction of
coagulopathy as compared to FFP and Vitamin K
The factors in plasma are relatively
dilute and a large volume is required for clinical reversal of oral anticoagulants
There is less risk of _____ with factor complex concentrates
infection and noninfectious transfusion reactions
The action of factor complex concentrates still require
adequate concentrations of platelets and fibrinogen
