Rebellion in EM - June 20, 2018 - By Scott Wieters
"3 Questions to ask when Dealing with a Patient Bleeding from DOACs:
- When was the last time medication was taken?
- What is the half-life of the medication?
- 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"