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Reversing Coagulopathy in Patients with Suspected GI Bleed

  • Kathleen Ogle
  • Andrew C. MeltzerEmail author
Chapter

Abstract

Excessive bleeding is a risk for anyone on anticoagulants. For patients with significant gastrointestinal bleeding, reversal of anticoagulation is usually needed to stop the bleeding. The effects of warfarin are reversed with vitamin K; however, reversal may take many hours. Fresh frozen plasma (FFP) and prothrombin complex concentrate (PCC) will provide more rapid reversal for patients on warfarin who are actively bleeding. In recent years, direct-acting oral anticoagulants (DOACs) are more common. Only one DOAC, dabigatran, currently has a specific reversal agent to stop bleeding.

Keywords

Coagulopathy reversal Vitamin K antagonists Direct-acting oral anticoagulants (DOACs) Gastrointestinal hemorrhage 

References

  1. 1.
    Gralnek I, Dumonceau J-M, Kuipers E, et al. Diagnosis and management of nonvariceal upper gastrointestinal hemorrhage: European Society of Gastrointestinal Endoscopy (ESGE) guideline. Endoscopy. 2015;47(10):a1–46.CrossRefGoogle Scholar
  2. 2.
    Pollack CV. Managing bleeding in anticoagulated patients in the emergency care setting. J Emerg Med. 2013;45(3):467–77.CrossRefGoogle Scholar
  3. 3.
    Lankiewicz MW, Hays J, Friedman KD, Tinkoff G, Blatt PM. Urgent reversal of warfarin with prothrombin complex concentrate. J Thromb Haemost. 2006;4(5):967–70.CrossRefGoogle Scholar
  4. 4.
    Hickey M, Gatien M, Taljaard M, Aujnarain A, Giulivi A, Perry JJ. Outcomes of urgent warfarin reversal with frozen plasma versus prothrombin complex concentrate in the emergency department. Circulation. 2013;128(4):360–4.CrossRefGoogle Scholar
  5. 5.
    Dentali F, Marchesi C, Pierfranceschi MG, et al. Safety of prothrombin complex concentrates for rapid anticoagulation reversal of vitamin K antagonists. Thromb Haemost. 2011;106(3):429–38.PubMedGoogle Scholar
  6. 6.
    Radaelli F, Dentali F, Repici A, et al. Management of anticoagulation in patients with acute gastrointestinal bleeding. Dig Liver Dis. 2015;47(8):621–7.CrossRefGoogle Scholar
  7. 7.
    Johansen M, Wikkelsø A, Lunde J, Wetterslev J, Afshari A. Prothrombin complex concentrate for reversal of vitamin K antagonist treatment in bleeding and non-bleeding patients. Cochrane Database Syst Rev. 2015;7:CD010555.Google Scholar
  8. 8.
    Dias JD, Norem K, Doorneweerd DD, Thurer RL, Popovsky MA, Omert LA. Use of thromboelastography (TEG) for detection of new oral anticoagulants. Arch Pathol Lab Med. 2015;139(5):665–73.CrossRefGoogle Scholar
  9. 9.
    Samuelson BT, Cuker A. Measurement and reversal of the direct oral anticoagulants. Blood Rev. 2017;31(1):77–84.  https://doi.org/10.1016/j.blre.2016.08.006.CrossRefPubMedGoogle Scholar
  10. 10.
    Zahir H, Brown KS, Vandell AG, et al. Edoxaban effects on bleeding following punch biopsy and reversal by a 4-factor prothrombin complex concentrate. Circulation. 2015;131(1):82–90.CrossRefGoogle Scholar
  11. 11.
    Eerenberg ES, Kamphuisen PW, Sijpkens MK, Meijers JC, Buller HR, Levi M. Reversal of rivaroxaban and dabigatran by prothrombin complex concentrate: a randomized, placebo-controlled, crossover study in healthy subjects. Circulation. 2011;124(14):1573–9.CrossRefGoogle Scholar
  12. 12.
    Pollack CV, Reilly PA, Eikelboom J, et al. Idarucizumab for Dabigatran Reversal. N Engl J Med. 2015;373(6):511–20.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of Emergency MedicineGeorge Washington University School of Medicine & Health SciencesWashington, DCUSA

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