In the absence of formal guidance, hospitals are combing through those case reports, looking at the (very sparse) literature on how to try to manage bleeding in patients taking the newer agents. “That, understandably, makes doctors uncomfortable.” That’s particularly true as case reports of catastrophic bleeds make their way into the literature or crop up in institutions. “There is no evidence-based antidote or reversal strategy for these drugs,” says Michael Streiff, MD, medical director of the Johns Hopkins anticoagulation management service in Baltimore. If the culprit is warfarin or heparin, doctors can rely on tried-and-true reversal strategies and antidotes: vitamin K, recombinant factor VII, and maybe fresh frozen plasma (FFP) for warfarin and aggressive protamine dosing for heparin.īut that’s far from the case if the bleeding is associated with dabigatran, the new, oral direct thrombin inhibitor, rivaroxaban or the very recently approved apixaban, both factor Xa inhibitors.
IT’S ALWAYS A CHALLENGE when an anticoagulated patient is admitted to the hospital with a serious bleed or develops one in-house. Published in the May 2013 issue of Today’s Hospitalist
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