![]() ![]() Remind patients of the signs and symptoms of bleeding and encourage them to always read the patient information leaflet that accompanies their medicinesĮnsure patients with renal impairment receive an appropriate dose (see advice below) and monitor renal function during treatment to ensure dose remains appropriate ![]() Remain vigilant for signs and symptoms of bleeding complications during treatment, especially patients with increased bleeding risk All other patients should likely restart their anticoagulation as soon as it is medically safe to do so.Use caution if prescribing direct-acting oral anticoagulants (DOACs) to patients at increased risk of bleeding (for example, older people or people with renal impairment) If bleeding occurred in a critical organ or the source has not been identified, then a delayed restart of anticoagulation is recommended. If the patient is at low thromboembolic risk (e.g., atrial fibrillation with CHA 2DS 2-VASc score 3 months prior), then discontinuing anticoagulation is recommended. Once bleeding is controlled, patients should be assessed for restarting their anticoagulant.PCC can be used if andexanet alpha is not available. For patients taking factor Xa inhibitors, use of andexanet alpha is recommended for reversal.PCC or activated PCC can be used if idarucizumab is not available. For patients taking dabigatran, idarucizumab 5 g IV should be used for reversal.Fresh frozen plasma can be used if a 4f-PCC is not available. Reversal agents should not be used for most patients with a nonmajor bleeding event.įor patients taking warfarin or other VKA, use of a four-factor prothrombin complex concentrate (4f-PCC) is advised for reversal. Use of an anticoagulant “reversal” or hemostatic agent should be considered for life-threatening bleeding or major bleeding that does not resolve with initial management. Antiplatelet therapy can also be stopped. Anti-factor Xa levels (either general or drug-specific) can be used to exclude clinically relevant levels for factor Xa inhibitors.įor patients with major bleeding or bleeding that requires intervention, use of vitamin K should be used to help reverse vitamin K antagonist (VKA). When quantitative tests of anticoagulant effect (e.g., dilute thrombin time for dabigatran, anti-factor Xa for factor Xa inhibitors) are not available, a qualitative test can be used to exclude clinically relevant drug levels.įor patients with dabigatran, a normal thrombin time or activated partial thromboplastin time usually excludes clinically relevant levels if sensitive reagents are used.Any bleed that requires hospitalization, surgical procedure, or transfusion likely requires interruption of the anticoagulant along with appropriate measures to control the source of bleeding.When a major bleed occurs, temporarily stopping the anticoagulant and initiating measures to control the bleeding source are required. ![]()
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