By rray, 25 March, 2024 Give idarucizumab B NR or activated PCC C LD if idarucizumab not available Consider hemodialysis but may not be practical due to coagulopathy and hemodynamic instability
By rray, 25 March, 2024 Activated PCC 50 units kg x1 Onset 30min Duration 12h Coagulation parameters don t correlate w efficacy Not effective to reverse factor Xa inhibitors
By rray, 25 March, 2024 Idarucizumab 5 g 2 separate vials of 2 5 g vial IV over 5min Additional 5 g may be given if reappearance of bleeding w elevated coagulation parameters or if 2nd emergency surgery procedure required and elevated coagulation parameters Onset 5min Duration 1
By rray, 25 March, 2024 Compress bleeding sites mechanically if accessible Assess hemodynamic status CBC renal fxn and last OAC dose Consider checking diluted thrombin time aPTT ecarin clotting time or ecarin chromogenic assay for dabigatran Some tests not readily available and
By rray, 25 March, 2024 Andexanet alfa If last factor Xa inhibitor dose 8h prior give low dose 400 mg bolus at target rate 30 mg min followed by 4 mg min up to 120min If last dose 5 mg apixaban 10 mg rivaroxaban give high dose 800 mg bolus over 30min then 8 mg min x120min Onset
By rray, 25 March, 2024 Give andexanet alfa apixaban rivaroxaban B NR edoxaban C LD or 4F PCC Balfaxar Kcentra C LD to rapidly reverse effects Activated PCC not effective Consider replacement of platelets per ESC
By rray, 25 March, 2024 Peer reviewed & based on multiple guidelines/recommendations from specialty societies/government agencies.