Difference between revisions of "Anticoagulant reversal for life-threatening bleeds"
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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%|| | + | | [[Dalteparin]] (Fragmin®)||3-5 hrs (longer in renal impairment)||~ 20%|| |
*Use protamine for partial neutralization (~60%) | *Use protamine for partial neutralization (~60%) | ||
− | *Protamine IV: | + | *[[Protamine]] IV: |
− | **< 8 hours since last | + | **< 8 hours since last dose: [[Protamine]] 50 mg |
− | **8-12 hours since last | + | **8-12 hours since last dose: [[Protamine]] 25 mg |
− | **>12 hours since last | + | **>12 hours since last 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 | *Dose of protamine for each 100 units dalteparin or 1mg of enoxaparin administered | ||
*Obtain baseline anti-Xa activity level | *Obtain baseline anti-Xa activity level | ||
*Monitor anti-Xa activity level to confirm reversal | *Monitor anti-Xa activity level to confirm reversal | ||
|- | |- | ||
− | | Enoxaparin (Lovenox®)||||||As above | + | | [[Enoxaparin]] (Lovenox®)||||||As above |
|- | |- | ||
− | | | + | | [[Hepari]]n||30-90 min (dose dependent)||Partial|| |
*Turn off infusion | *Turn off infusion | ||
− | *Protamine 50 mg IV | + | *[[Protamine]] 50 mg IV |
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Revision as of 07:12, 25 March 2016
Contents
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