![]() ![]() Involve your thrombosis colleagues early to help arrange re-starting therapy after the acute phase. Therefore, all patients on Warfarin therapy with mechanical valves should be reversed. within 2-weeks, there is no increased risk of thromboembolic events (3). However, evidence suggests that the immediate risks of thrombotic complications are largely overstated. One of the common uses of Warfarin is in patients with mechanical heart valves, which makes emergency physicians hesitate on reversal due to the potential risk of clotting events off these agents. Since warfarin induces anticoagulation by inhibiting the synthesis of these factors, the simple and easy reversal strategy is to replace them. By inhibiting this enzyme, there is a functional loss of vitamin K, leading to reduced production of vitamin-K dependent coagulation factors – X, IX, VII, II, protein C&S. Wafarin inhibits vitamin K epoxide reductase complex 1in the liver, an enzyme that is used to activate vitamin K to be used as a co-factor in the body. In my practice I use the criteria set by the International Society for Thrombosis and Haemostasis (ISTH), which is endorsed by Thrombosis Canada (2): However, there are many definitions of what constitutes a major or life-threatening bleed. It is our role in the ED to understand how these drugs and their reversal agents in order to help patients, and you should consider reversal in all major or life-threatening bleeds. This post will review indications for reversal in the emergency room patient and provide you with an up-to-date, evidence-informed approach to anticoagulation (Warfarin, DOACs) and antiplatelet reversal for your next shift. ![]() Two important questions for any bleeding patient on these agents: And i n particular cases, such intra-cerebral hemorrhage (~15-20%) (1), or unstable trauma patients, having an approach to reversal of these agents can be life-altering. The use of these agents and their complications are extremely common. ![]() How many times on shift do you see a patient that is on an anticoagulant or antiplatelet agent? The answer is probably almost always. ![]()
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