Reversal of Anticoagulants in Critical Care

JOURNAL TITLE: Indian Journal of Critical Care Medicine

Author
1. Kandasamy Subramani
ISSN
0972-5229
DOI
10.5005/jp-journals-10071-23257
Volume
23
Issue
S3
Publishing Year
2019
Pages
1
Author Affiliations
    1. Department of Critical Care Medicine, Christian Medical College, Vellore, Tamil Nadu, India
  • Article keywords
    Anticoagulant, Critical care, Direct thrombin inhibitors, Protamine, Reversal, Vitamin K antagonists

    Abstract

    There has seen an increase in anticoagulant consumption worldwide over the past few decades. With this widespread utilization of anticoagulants, clinicians are increasingly likely to encounter situations where anticoagulants would need to be withheld. This includes emergency and elective procedures or surgeries as well as major or minor bleeding as a direct result of over anticoagulation or consequent to other intercurrent illnesses such as sepsis or trauma with multiorgan failure, where the anticoagulant may contribute to coagulation abnormalities. Clinicians are required to have a thorough understanding of the indications for anticoagulant prescription, drug interactions and monitoring, indications and options of reversal of anticoagulation and management of bleeding in the situations described above. Once the acute process is managed, the ongoing need and timing of reinitiation of anticoagulation is also crucial. This article provides an overview on the indications for reversal of anticoagulation, the agents used for reversal and the timing of reinitiation of anticoagulants.

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