requirement of red blood cell transfusion of two units or more.overt bleeding with a drop in haemoglobin of two units or more.The main question here is: does the patient have major bleeding? Think about the patient’s clinical presentation and assess whether they are haemodynamically stable.Ī major bleed can be defined as a patient having at least one of the following: This could include other medications such as anti-platelet therapy or medical conditions such as liver cirrhosis or thrombocytopenia.Īlso, remember that renal or hepatic dysfunction can affect the clearance of oral anticoagulants and therefore prolong their effect. > Are there any other factors affecting the patient’s clotting? Depending on the half-life of the drug, you may be able to avoid actively reversing it. It is useful to find out what dose of anticoagulant the patient is on and when they last took it. Patients on anticoagulation for indications such as atrial fibrillation are potentially at less risk if their anticoagulant is stopped or reversed acutely compared to patients who have a mechanical heart valve, for example. There are a few things to consider in particular when weighing up the two sides: Ultimately, as with most decisions in medicine, the decision to reverse anticoagulation depends on the risk versus the benefit of doing so for that individual patient.

Deciding whether or not to reverse anticoagulation in these situations is a key part of emergency management. Another group of patients where anticoagulant reversal may be considered is in those who have taken an oral anticoagulant overdose. Anticoagulants impact upon presenting complaint to the ED, for example, with a head injury, trauma or a gastrointestinal bleed. Common reasons for being prescribed an anticoagulant include atrial fibrillation, a mechanical heart valve or previous pulmonary embolism. Patients who are taking an oral anticoagulant present to the Emergency Department (ED) fairly frequently. Authors: Jasmine Medhora / Editor: Liz Herrieven / Codes: HAP7, PAP11, HC1, HP2, SLO1, SuC13 / Published:

Xa inhibitor reversal