Anticoagulant reversal for life-threatening bleeds: Difference between revisions
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===Factor Xa Inhibitors=== | |||
{| {{table}} | {| {{table}} | ||
| align="center" style="background:#f0f0f0;"|'''Anticoagulants''' | | align="center" style="background:#f0f0f0;"|'''Anticoagulants''' | ||
| align="center" style="background:#f0f0f0;"|'''Half-life''' | | align="center" style="background:#f0f0f0;"|'''Half-life''' | ||
| Line 6: | Line 6: | ||
| align="center" style="background:#f0f0f0;"|'''Strategies to reverse or minimize anticoagulant effects''' | | align="center" style="background:#f0f0f0;"|'''Strategies to reverse or minimize anticoagulant effects''' | ||
|- | |- | ||
| Apixaban (Eliquis®)||8-15 hrs (longer in renal impairment)||No||*If ingested within 2 hours, administer activated charcoal *4-factor PCC (Kcentra™)^ **25units/kg—max 2500 units for treatment of documented intracranial hemorrhage **50 units/kg—max 5000 units for all other life-threatening bleeds | |||
|- | |- | ||
| Edoxaban (Savaysa®)||10-14 hrs (longer in renal impairment)||~ 25%||As above | |||
|- | |- | ||
| Rivaroxaban (Xarelto®)||9-13 hrs (longer in renal impairment)||No||As above | |||
|- | |- | ||
| Fondaparinux (Arixtra®)||17-21 hrs (significantly longer in renal impairment)||No||4-factor PCC (Kcentra™)* 50 units/kg—max 5000 units | |||
|} | |||
===Direct Thrombin Inhibitor=== | |||
{| {{table}} | |||
| align="center" style="background:#f0f0f0;"|'''Anticoagulants''' | |||
| align="center" style="background:#f0f0f0;"|'''Half-life''' | |||
| align="center" style="background:#f0f0f0;"|'''Removed by HD''' | |||
| align="center" style="background:#f0f0f0;"|'''Strategies to reverse or minimize anticoagulant effects''' | |||
|- | |- | ||
| Argatroban||40-50 min ||~ 20%||Turn off infusion | |||
|- | |- | ||
| Bivalirudin (Angiomax®)||25 min (up to 1 hr in severe renal impairment)||~ 25%||As above | |||
|- | |- | ||
| Dabigatran (Pradaxa®)||14-17 hrs (up to 34 hrs in severe renal impairment)||~ 65%||If ingested within 2 hours, administer activated charcoal *Idarucizumab (Praxbind®) 5g IV *For end stage renal disease patient with pre-existing vascular access, consult nephrology to consider dialysis. | |||
|} | |||
===Heparins=== | |||
{| {{table}} | |||
| align="center" style="background:#f0f0f0;"|'''Anticoagulants''' | |||
| align="center" style="background:#f0f0f0;"|'''Half-life''' | |||
| align="center" style="background:#f0f0f0;"|'''Removed by HD''' | |||
| align="center" style="background:#f0f0f0;"|'''Strategies to reverse or minimize anticoagulant effects''' | |||
|- | |- | ||
| Dalteparin (Fragmin®)||3-5 hrs (longer in renal impairment)||~ 20%||*Use protamine for partial neutralization (~60%) *Protamine IV: **< 8 hours since last LMWH dose: Protamine 50 mg **8-12 hours since last LMWH dose: Protamine 25 mg **>12 hours since last LMWH dose: Unlikely useful unless CrCl < 30 mL/min (or 25mg fixed dose)* Dose of protamine for each 100 units dalteparin or 1mg of enoxaparin administered *Obtain baseline anti-Xa activity level *Monitor anti-Xa activity level to confirm reversal | |||
|- | |- | ||
| Enoxaparin (Lovenox®)||||||As above | |||
|- | |- | ||
| Heparin||30-90 min (dose dependent)||Partial||*Turn off infusion *Protamine 50 mg IV | |||
|} | |} | ||
Revision as of 07:06, 25 March 2016
Factor Xa Inhibitors
| Anticoagulants | Half-life | Removed by HD | Strategies to reverse or minimize anticoagulant effects |
| Apixaban (Eliquis®) | 8-15 hrs (longer in renal impairment) | No | *If ingested within 2 hours, administer activated charcoal *4-factor PCC (Kcentra™)^ **25units/kg—max 2500 units for treatment of documented intracranial hemorrhage **50 units/kg—max 5000 units for all other life-threatening bleeds |
| Edoxaban (Savaysa®) | 10-14 hrs (longer in renal impairment) | ~ 25% | As above |
| Rivaroxaban (Xarelto®) | 9-13 hrs (longer in renal impairment) | No | As above |
| Fondaparinux (Arixtra®) | 17-21 hrs (significantly longer in renal impairment) | No | 4-factor PCC (Kcentra™)* 50 units/kg—max 5000 units |
Direct Thrombin Inhibitor
| Anticoagulants | Half-life | Removed by HD | Strategies to reverse or minimize anticoagulant effects |
| Argatroban | 40-50 min | ~ 20% | Turn off infusion |
| Bivalirudin (Angiomax®) | 25 min (up to 1 hr in severe renal impairment) | ~ 25% | As above |
| Dabigatran (Pradaxa®) | 14-17 hrs (up to 34 hrs in severe renal impairment) | ~ 65% | If ingested within 2 hours, administer activated charcoal *Idarucizumab (Praxbind®) 5g IV *For end stage renal disease patient with pre-existing vascular access, consult nephrology to consider dialysis. |
Heparins
| Anticoagulants | Half-life | Removed by HD | Strategies to reverse or minimize anticoagulant effects |
| Dalteparin (Fragmin®) | 3-5 hrs (longer in renal impairment) | ~ 20% | *Use protamine for partial neutralization (~60%) *Protamine IV: **< 8 hours since last LMWH dose: Protamine 50 mg **8-12 hours since last LMWH dose: Protamine 25 mg **>12 hours since last LMWH dose: Unlikely useful unless CrCl < 30 mL/min (or 25mg fixed dose)* Dose of protamine for each 100 units dalteparin or 1mg of enoxaparin administered *Obtain baseline anti-Xa activity level *Monitor anti-Xa activity level to confirm reversal |
| Enoxaparin (Lovenox®) | As above | ||
| Heparin | 30-90 min (dose dependent) | Partial | *Turn off infusion *Protamine 50 mg IV |