anticoagulation reversal

• related: Hemeonc
• tags: #hemeonc

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Pradaxa (dabigatran)

Use Praxbind (idarucizumab) for Pradaxa reversal. Dialysis is alternative but could take too long and could have problem with vas cath insertion when bleeding.

Check PTT and thrombin time if available

Eliquis and Xarelto

Use Kcentra or FEIBA for reversal.

• FEIBA is 4 factor concentrates: 2, 7, 9, 10
• Kcentra has 2, 7, 9, 10 but also protein C and S but could take longer to get

check anti-xa?

Heparin

Use protamine sulfate? Check PTT

Warfarin

Use Vitamin K, FFP or PCC. PCC is preferred. Follow INR every 3-6 hours until adequate reversal

Check PT/INR

dabigatran

• Dabigatran: Pradaxa
• Idarucizumab: Praxbind
• Kcentra: PCC
• can dialyse but difficult if they are already having bleeding issues

10 reversal

• Rivaroxaban/apixaban instead
• Kcentra and FEIBA (factor 8 inhibitor bypassing agent, originally designed for hemophilia 8 patients. FEIBA has activated 2, 7, 9, 10)
• very expensive and need to be continuously infused. Very new