Wednesday, June 20, 2018

DOAC Reversal

 R.E.B.E.L. EM - Emergency Medicine Blog
Rebellion in EM - June 20, 2018 - By Scott Wieters
"3 Questions to ask when Dealing with a Patient Bleeding from DOACs:
  1. When was the last time medication was taken?
  2. What is the half-life of the medication?
  3. What is the renal function? – Chronic kidney disease or acute kidney injury may make DOACs more potent
Shape of the TEG + Alcohol Glass = What is Needed:

Brandy Tumbler = Normal (Do Nothing)
Champagne Flute = Give Cryo
Red Wine Glass = Give Platelets
Martini Glass = Give TXA
Test Tube = Give Platelets

Take Home Messages for DOAC Reversal:
  • Xa Reversal Summary: 4 Factor PCC 50U/kg + TXA 1g IV –> Consider Andexanet Alpha when available –> In the Future Ciraparantag
  • IIa Reversal Summary: Idarucizumab 5g IV + TXA 1g –> If no Idarucizumab available, consider FEIBA 50U/kg –> In the Future Ciraparantag"