Anticoagulant reversal for life-threatening bleeds: Difference between revisions
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| Bivalirudin (Angiomax®)||25 min (up to 1 hr in severe renal impairment)||~ 25%||As above | | Bivalirudin (Angiomax®)||25 min (up to 1 hr in severe renal impairment)||~ 25%||As above | ||
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| 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. | | 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. | |||
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| align="center" style="background:#f0f0f0;"|'''Strategies to reverse or minimize anticoagulant effects''' | | align="center" style="background:#f0f0f0;"|'''Strategies to reverse or minimize anticoagulant effects''' | ||
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| 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 | | 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 | |||
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| Enoxaparin (Lovenox®)||||||As above | | Enoxaparin (Lovenox®)||||||As above | ||
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| Heparin||30-90 min (dose dependent)||Partial||*Turn off infusion *Protamine 50 mg IV | | Heparin||30-90 min (dose dependent)||Partial|| | ||
*Turn off infusion | |||
*Protamine 50 mg IV | |||
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^Off-label | |||
==See Also== | ==See Also== | ||
Revision as of 07:11, 25 March 2016
Factor Xa Inhibitors
| Anticoagulant | Half-life | Removed by HD | Strategies to reverse or minimize anticoagulant effects |
| Apixaban (Eliquis®) | 8-15 hrs (longer in renal impairment) | No |
|
| 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% |
|
Heparins
| Anticoagulants | Half-life | Removed by HD | Strategies to reverse or minimize anticoagulant effects |
| Dalteparin (Fragmin®) | 3-5 hrs (longer in renal impairment) | ~ 20% |
|
| Enoxaparin (Lovenox®) | As above | ||
| Heparin | 30-90 min (dose dependent) | Partial |
|
^Off-label