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Management of Chronically Anticoagulated Patients

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Trauma Induced Coagulopathy

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Abstract

Anticoagulant therapies are widely used for the prevention of thrombotic events, but are associated with a risk of bleeding. The advent of the newer oral anticoagulants (NOACs) that are target specific (i.e., factor IIa or Xa inhibitors) further compounds this risk as there is currently a lack of validated strategies for their reversal. While interruption of anticoagulant therapy may be sufficient for patients scheduled for elective surgery or those presenting with minor bleeding, patients with acute major bleeding or requiring an urgent surgery need rapid anticoagulation reversal. Based mostly on preclinical and volunteer reversal data, guidelines currently recommend the use of hemostatic agents, such as prothrombin complex concentrates for NOAC reversal in patients with life-threatening bleeding. Similarly, antiplatelet agents are key to the management of patients with ischemic cardiovascular disease and/or atherosclerotic vascular disease, but they too pose a risk of bleeding. Some hemostatic therapies, such as rFVIIa, may have potential for the reversal of P2Y12 receptor inhibitors; however, data supporting this approach are limited. Specific antidotes are currently available for dabigatran (idarucizumab), and under development for the other NOACs Ultimately, adequately powered studies are required to fully validate reversal strategies for NOACs and antiplatelet agents.

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Authors and Affiliations

  1. Duke University Medical Center, Duke University School of Medicine, 2301 Erwin Rd, 5691H HAFS, Box 3094, Durham, NC, 27710, USAUSA

    Jerrold H. Levy M.D., F.A.H.A., F.C.C.M.

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  1. Jerrold H. Levy M.D., F.A.H.A., F.C.C.M.
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Correspondence to Jerrold H. Levy M.D., F.A.H.A., F.C.C.M. .

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Editors and Affiliations

  1. Dept of Surgery & Trauma Research Center, Univ of Colorado School of Medicine, Aurora, Colorado, USA

    Eduardo Gonzalez

  2. Dept of Surgery & Trauma Research Center, Univ of Colorado School of Medicine, Aurora, Colorado, USA

    Hunter B. Moore

  3. Dept of Surgery & Trauma Research Center, Univ of Colorado Sch of Med&Denver Healt, Denver, Colorado, USA

    Ernest E. Moore

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Levy, J.H. (2016). Management of Chronically Anticoagulated Patients. In: Gonzalez, E., Moore, H., Moore, E. (eds) Trauma Induced Coagulopathy. Springer, Cham. https://doi.org/10.1007/978-3-319-28308-1_33

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  • DOI: https://doi.org/10.1007/978-3-319-28308-1_33

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