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Emergency Reversal of Anticoagulants

Abstract

Anticoagulant agents are often used for the prevention and treatment of a wide range of cardiovascular diseases. The most frequently used anticoagulants are heparin or its derivatives, vitamin K antagonists (such as warfarin or coumadin) and antiplatelet agents, including aspirin and thienopyridine derivatives, such as clopidogrel. A myriad of clinical studies have demonstrated that these agents (alone or in combination) can prevent or treat acute or chronic thromboembolic complications, such as in patients with atrial fibrillation or prosthetic heart valves, after myocardial infarction or ischemic stroke, and in patients with venous thrombosis or pulmonary embolism [1]. The most important complication of treatment with anticoagulants is hemorrhage, which may be serious, may cause long-term debilitating disease, or may even be life-threatening [2]. In well-controlled patients in clinical trials, treatment with vitamin K antagonists increases the risk of major bleeding by 0.5 %/year and the risk of intracranial hemorrhage by about 0.2 %/year [3]. In a very large series of 34146 patients with acute ischemic coronary syndromes, anticoagulant-associated bleeding was associated with a 5-fold increased risk of death during the first 30 days and a 1.5-fold higher mortality between 30 days and 6 months [4]. Major bleeding was an independent predictor of mortality across all subgroups that were analyzed. In some clinical situations, the incidence of serious bleeding complications may annihilate or even overwhelm the efficacy of antithrombotic agents, as has been shown in the secondary prevention of patients with ischemic stroke by vitamin K antagonists [5].

Keywords

Disseminate Intravascular Coagulation Anticoagulant Effect Dabigatran Etexilate Recombinant Factor VIIa Protamine Sulfate 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2009

Authors and Affiliations

  • M. Levi
    • 1
  1. 1.Department of Medicine (F-4) Academic Medical CenterUniversity of AmsterdamAmsterdamNetherlands

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