Abstract
Excessive bleeding is a risk for anyone on anticoagulants. For patients with significant gastrointestinal bleeding, reversal of anticoagulation is usually needed to stop the bleeding. The effects of warfarin are reversed with vitamin K; however, reversal may take many hours. Fresh frozen plasma (FFP) and prothrombin complex concentrate (PCC) will provide more rapid reversal for patients on warfarin who are actively bleeding. In recent years, direct-acting oral anticoagulants (DOACs) are more common. Only one DOAC, dabigatran, currently has a specific reversal agent to stop bleeding.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Gralnek I, Dumonceau J-M, Kuipers E, et al. Diagnosis and management of nonvariceal upper gastrointestinal hemorrhage: European Society of Gastrointestinal Endoscopy (ESGE) guideline. Endoscopy. 2015;47(10):a1–46.
Pollack CV. Managing bleeding in anticoagulated patients in the emergency care setting. J Emerg Med. 2013;45(3):467–77.
Lankiewicz MW, Hays J, Friedman KD, Tinkoff G, Blatt PM. Urgent reversal of warfarin with prothrombin complex concentrate. J Thromb Haemost. 2006;4(5):967–70.
Hickey M, Gatien M, Taljaard M, Aujnarain A, Giulivi A, Perry JJ. Outcomes of urgent warfarin reversal with frozen plasma versus prothrombin complex concentrate in the emergency department. Circulation. 2013;128(4):360–4.
Dentali F, Marchesi C, Pierfranceschi MG, et al. Safety of prothrombin complex concentrates for rapid anticoagulation reversal of vitamin K antagonists. Thromb Haemost. 2011;106(3):429–38.
Radaelli F, Dentali F, Repici A, et al. Management of anticoagulation in patients with acute gastrointestinal bleeding. Dig Liver Dis. 2015;47(8):621–7.
Johansen M, Wikkelsø A, Lunde J, Wetterslev J, Afshari A. Prothrombin complex concentrate for reversal of vitamin K antagonist treatment in bleeding and non-bleeding patients. Cochrane Database Syst Rev. 2015;7:CD010555.
Dias JD, Norem K, Doorneweerd DD, Thurer RL, Popovsky MA, Omert LA. Use of thromboelastography (TEG) for detection of new oral anticoagulants. Arch Pathol Lab Med. 2015;139(5):665–73.
Samuelson BT, Cuker A. Measurement and reversal of the direct oral anticoagulants. Blood Rev. 2017;31(1):77–84. https://doi.org/10.1016/j.blre.2016.08.006.
Zahir H, Brown KS, Vandell AG, et al. Edoxaban effects on bleeding following punch biopsy and reversal by a 4-factor prothrombin complex concentrate. Circulation. 2015;131(1):82–90.
Eerenberg ES, Kamphuisen PW, Sijpkens MK, Meijers JC, Buller HR, Levi M. Reversal of rivaroxaban and dabigatran by prothrombin complex concentrate: a randomized, placebo-controlled, crossover study in healthy subjects. Circulation. 2011;124(14):1573–9.
Pollack CV, Reilly PA, Eikelboom J, et al. Idarucizumab for Dabigatran Reversal. N Engl J Med. 2015;373(6):511–20.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2019 Springer Nature Switzerland AG
About this chapter
Cite this chapter
Ogle, K., Meltzer, A.C. (2019). Reversing Coagulopathy in Patients with Suspected GI Bleed. In: Graham, A., Carlberg, D.J. (eds) Gastrointestinal Emergencies. Springer, Cham. https://doi.org/10.1007/978-3-319-98343-1_16
Download citation
DOI: https://doi.org/10.1007/978-3-319-98343-1_16
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-98342-4
Online ISBN: 978-3-319-98343-1
eBook Packages: MedicineMedicine (R0)