Written by Clay Smith
Spoon Feed
This is a helpful summary of anticoagulant reversal agents. However, recommendations were largely based on expert opinion, with a significant number of conflicts of interest disclosed by the authors.
Why does the matter?
Bleeding anticoagulated patients are extremely high risk, or they may not be bleeding but may need emergency procedures or surgery requiring reversal. Most reversal agents are costly, so they shouldn’t be wasted. But many presentations are life-threatening; so, they should be used when needed.
Bleeding is costly…
This was a review article on anticoagulant agents and current reversal agents that relied heavily on expert opinion. Most of the authors disclosed conflicts of interest (COI), with funding from Portola (maker of andexanet alfa), Boehringer Ingelheim (maker of idarucizumab), Janssen (maker of rivaroxaban), and others. That said, these are truly experts in this field. So, with that important disclosure, let’s see what we can learn.
First, the image from the article was very helpful in showing us the big picture.
Next was the proposed management strategy by the expert panel. Bear in mind that the evidence for some of these therapies, including andexanet alfa, is not strong at this point.
This is a summary of the anticoagulant reversal agents. Please see the original version in the full text article, as it is much more complete and has additional elements included.
Source
Baugh CW1, Levine M2, Cornutt D3, Wilson JW4, Kwun R5, Mahan CE6, Pollack CV Jr7, Marcolini EG8, Milling TJ Jr9, Peacock WF10, Rosovsky RP11, Wu F12, Sarode R13, Spyropoulos AC14, Villines TC15, Woods TD16, McManus J17, Williams J18. Anticoagulant Reversal Strategies in the Emergency Department Setting: Recommendations of a Multidisciplinary Expert Panel. Ann Emerg Med. 2019 Nov 13. pii: S0196-0644(19)31181-3. doi: 10.1016/j.annemergmed.2019.09.001. [Epub ahead of print]
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