Anticoagulant Reversal Flashcards
How is warfarin reversed?
Vitamin K 10mg over 10 minutes
ICH: Kcentra 2500 units
Other bleed: Kcentra 1500 units
Check INR in 30 minutes and give additional PCC if >1.5
How is Eliquis and Xarelto reversed?
Kcentra 50 units/kg with max of 5,000 units
How is pradaxa reversed?
Praxbind 5 grams (2 vials)
If not available, use PCC
What additional medication should be considered when reversing an anticoagulant during an acute bleed?
TXA
1g over 15 minutes
When are platelets indicated in reversing a bleed?
Usually only if <50,000
May consider if <100,000 in ICH
In general, how long from last dose is the anticoagulant effect of NOAC’s thought to be gone?
About 3 days for most
How are PT/PTT used to determine the anticoagulant status of DOAC’s and the need for reversal in a bleed?
PT/PTT have no role in determining if DOACs are therapeutic or not and do not play a role in deciding whether or not to reverse in an acute bleed
What medication is given to reverse heparin or lovenox?
Protamine
How should minor bleeding on warfarin be managed?
Hold warfarin, give 2.5-5mg Vit. K orally
What is the onset of action for IV vitamin K in reversal?
4-12 hours
