Emergent Reversal of Anticoagulants Flashcards
reversal for antiplatelet
platelet transfusion
reversal for heparin
protamine
reversal for vitamin K antagonists
- 3 and 4 factor PCCs
- vitamin K
reversal for direct thrombin inhibitors
- idarucizumab
- andexanet alfa
FFP
- variable but near normal levels of coagulation factors, coagulation inhibitors, albumin, immunoglobulins
- large volumes not well tolerated in patient with limited cardiopulmonary reserve, can be associated with TRALI
- efficacy commonly assessed by PT/INR, PTT, fibrinogen level, plt count, viscoelastic tests
cryoprecipitate
-slowly thawing FFP leaves behind a cold-insoluble precipitate which contains fibrinogen, FVIII, vWF, and FXIII
factor concentrates
- plasma derived
- recombinant
blood product administration
- filter + warmer –> PRBCs, FFP, Cryo
- filter only (NO warmer) –> plts
plasma derived factor concentrates
- Riastap
- Profilnine
- KCentra
recombinant factor concentrates
Factor VIIa, Factor IX
Plasma Derived Fibrinogen Concentrate drug
Ristap
Ristap MOA
fractionated from blood and stored at room temp for up to 30 months
Ristap dose/route
concentrate standardized in each vial (900-1300 mg per 50 mL vial)
Ristap admin considerations
quickly reconstituted and administered IV with no thawing or blood type matching required
Factor Complex Concentrates drugs
Kcentra – 4 factor
Profilnine – 3 factor
Factor Complex Concentrates uses
- reverse effects of significant vitamin K-antagonism
- emergent or urgent surgery
- clotting deficiency
Factor Complex Concentrates contraindications
DIC and HIT
3 Factor Concentrate Profilnine MOA
complex concentrate which contains factors IX, II, X and low levels of VII
3 Factor Concentrate Profilnine dose
10-15 units/IBW kg; max dose 1000 units
3 Factor Concentrate Profilnine uses
- hemophilia B treatment
- reserved for cardiac cases
4 Factor Concentrate Kcentra MOA
contains antithrombotic proteins C and S and heparin; also factors II, VII, IX, and X
4 Factor Concentrate Kcentra uses
- reversal of vitamin K antagonists with INR > 1.5 and experiencing acute major bleeding
- potential to reverse factor Xa inhibitors
4 Factor Concentrate Kcentra risks
potential for increased risk of thrombosis in some settings, particularly in patients who do not have hemophilia
Recombinant Activated Factor VII drug
Novoseven
Novoseven composition
- form of blood factor VII
- glycoprotein produced by recombinant DNA technology
Novoseven MOA
-activated form of factor VII, causes coagulation without the need for factors VIII and IX
-promotes hemostasis by activating the extrinsic pathway of coagulation cascade
-theoretically, localizes action of factor VIIa to the site of injury
2 pathways:
-site of tissue injury combine with tissue factor directly activate factor X
-platelet surface
Novoseven PK/PD
E ½ 2-2.5 hours
Novoseven dose
- highly variable 20-200 mcg/kg
- 90 mcg/kg IV (most places use this dose)
- reconstitute with sterile water
- re-dose Q2H
Novoseven clinical use
- hemophilia A (deficiency of VIII)
- hemophilia B (deficiency of IX)
- congenital factor VII deficiency
- off label for prevention and treatment of major blood loss
Novoseven risks/considerations
- risk of thrombotic adverse events
- will not stop surgical hemorrhage
- reduce need for transfusion in patients with hemorrhagic shock from blunt trauma
- should not be given instead of other blood products, adequate FFP, cryo, and plts need to be present
- provide faster correction of coagulopathy
- less risk of infectious and noninfectious transfusion reactions
- dosing requires hematology and pharmacy consultations
