Help, I Cannot Stop the Bleeding!

  • Mark T. Friedman
  • Kamille A. West
  • Peyman Bizargity
  • Kyle Annen
  • Jeffrey S. Jhang


A 78-year-old man is brought to the emergency department (ED) after falling on ice and sustaining head trauma outside of his home. A computed tomography (CT) head scan shows intracranial hemorrhage (ICH). The patient is noted to have a medical history significant for nonvalvular atrial fibrillation for which he takes rivaroxaban anticoagulant medication 20 mg orally once daily. The patient is reported to weigh 65 kg. Coagulation laboratory studies show prothrombin time (PT) 17.2 s and activated partial thromboplastin time (aPTT) 30.0 s. A type and screen (ethylenediaminetetraacetic acid [EDTA] anticoagulant) is submitted to the blood bank along with a stat request for four units of fresh frozen plasma (FFP).


Apixaban Bebulin Dabigatran Edoxaban Idarucizumab International normalized ratio/INR Kcentra Novel anticoagulants/NOAC Profilnine Prothrombin complex concentrate/PCC Rivaroxaban Warfarin 


  1. 1.
    Gehrie E, Tormey C. Novel oral anticoagulants. Efficacy, laboratory measurement, and approaches to emergent reversal. Arch Pathol Lab Med. 2015;139:687–92.CrossRefGoogle Scholar
  2. 2.
    Ikeda K, Tachibana H. Clinical implication of monitoring rivaroxaban and apixaban by using anti-factor Xa assay in patients with non-valvular atrial fibrillation. J Arrhythm. 2016;32(1):42–50.CrossRefGoogle Scholar
  3. 3.
    Hu TY, Vaidya VR, Asirvatham SJ. Reversing anticoagulant effects of novel oral anticoagulants: role of ciraparantag, andexanet alfa, and idarucizumab. Vasc Health Risk Manag. 2016;12:35–44.PubMedPubMedCentralGoogle Scholar
  4. 4.
    Xarelto® Prescribing Information. Janssen Pharmaceuticals, Inc., Titusville, NJ. May 2016.Google Scholar
  5. 5.
    Eliquis® Prescribing Information. Bristol-Meyers Squibb Company, Princeton, NJ. July 2016.Google Scholar
  6. 6.
    SAVAYSA® Prescribing Information. Daiicho Sankyo, Inc., Basking Ridge, NJ. September 2017.Google Scholar
  7. 7.
    Milling TJ, Kaatz S. Preclinical and clinical data for factor Xa and “universal” reversal agents. Am J Emerg Med. 2016;34(11 Suppl):39–45.CrossRefGoogle Scholar
  8. 8.
    Kcentra® Prescribing Information. CSL Behring, LLC, Kankakee, IL. June 2017.Google Scholar

Recommended Reading

  1. 1.
    Yeh CH, Gross PL, Weitz JI. Evolving use of new oral anticoagulants for treatment of venous thromboembolism. Blood. 2014;124(7):1020–8.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Mark T. Friedman
    • 1
  • Kamille A. West
    • 2
  • Peyman Bizargity
    • 3
  • Kyle Annen
    • 4
  • Jeffrey S. Jhang
    • 1
  1. 1.Icahn School of MedicineMount Sinai Health SystemNew YorkUSA
  2. 2.Department of Transfusion MedicineNational Institutes of Health Clinical CenterBethesdaUSA
  3. 3.Department of Molecular & Human GeneticsBaylor College of MedicineHoustonUSA
  4. 4.Department of PathologyChildren’s Hospital ColoradoAuroraUSA

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