Management of bleeding complications in anticoagulated patients involves standard routines and, for severe cases, reversal of the anticoagulant effect using specific antidotes or nonspecific support.
How should bleeding complications be managed and anticoagulant effects reversed in patients on anticoagulant therapy?
This review provides a comprehensive overview of the management of bleeding complications and the reversal of various anticoagulant therapies in emergency settings.
Anticoagulant therapy is often refrained from out of fear of hemorrhagic complications. The most frequent type of major bleeding is gastrointestinal, but intracranial hemorrhage has the worst prognosis. Management of these complications in patients on anticoagulants should follow the same routines as for nonanticoagulated patients, as described here with the previously mentioned bleeds as examples. In addition, for life-threatening or massive hemorrhages, reversal of the anticoagulant effect is also crucial. Adequate reversal requires information on which anticoagulant the patient has taken and when the last dose was ingested. Laboratory data can be of some help, but not for all anticoagulants in the emergency setting. This is reviewed here for the different types of anticoagulants: vitamin K antagonists, heparins, fondaparinux, thrombin inhibitors and factor Xa inhibitors. Specific antidotes for the latter are becoming available, but supportive care and nonspecific support for hemostasis with antifibrinolytic agents or prothrombin complex concentrates, which are widely available, should be kept in mind.
Piran et al. (Mon,) conducted a review in Bleeding complications in patients on anticoagulant therapy. Management and reversal of anticoagulant therapy was evaluated. Management of bleeding complications in anticoagulated patients involves standard routines and, for severe cases, reversal of the anticoagulant effect using specific antidotes or nonspecific support.