![]() 2 Anti-platelet agents should be discontinued when an anticoagulant is used, except in certain circumstances. The benefits should be weighed against a patient's individual bleeding risk when deciding to anticoagulate and in choice of anticoagulant, and factors including potential drug–drug interactions and the need for dose reduction considered. It is important that care of patients on anticoagulant drugs is optimised so that the need for urgent reversal is minimised. This article will focus on urgent reversal of anticoagulation. This can be particularly challenging in situations such as bleeding in patients with mechanical heart valves. PCC = prothrombin complex concentrate LMWH = low-molecular-weight heparin UFH = unfractionated heparin → = promotes = suppressesĪ decision to reverse anticoagulation must weigh the benefits of anticoagulation reversal in terms of stopping bleeding or reduction of bleeding risk against the risk of development or extension of thrombosis while anticoagulation is reversed. 31 Please see the main text for details on specific drug and reversal agent mechanisms. This diagram is intended to summarise drug actions but does not reflect the complexity of haemostasis believed to occur physiologically, where cell surface molecules regulate initiation, amplification and propagation of thrombus. Representation of stage of action of anticoagulants and their reversal agents on a schematic clotting cascade. ![]() Finally, consideration of whether and when to reintroduce an anticoagulant drug following reversal is important not only to balance bleeding and thrombotic risks for individual patients but also for timely management of discharge. It is also necessary to reduce the need for reversal through correct prescribing and by employing appropriate periprocedural bridging strategies for elective and semi-elective procedures. An understanding of reversal strategies alone is insufficient to competently care for patients who may require anticoagulation reversal. Recognising effects upon, and limitations of, laboratory measures of coagulation also plays an important role. ![]() While supportive and general measures apply for patients on all agents, recent diversification in the number of licensed agents makes an understanding of drug-specific reversal strategies essential. Widespread use of anticoagulant drugs for treatment and prevention of thromboembolic events means it is common to encounter patients requiring reversal of anticoagulation for management of bleeding or invasive procedures.
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