Аннотация:
Anticoagulant therapy is often refrained from out of fear of hemorrhagic complications. The most frequent type of major bleeding is gastrointestinal, but intracranial hemorrhage has the worst prognosis. Management of these complications in patients on anticoagulants should follow the same routines as for nonanticoagulated patients, as described here with the previously mentioned bleeds as examples. In addition, for life-threatening or massive hemorrhages, reversal of the anticoagulant effect is also crucial. Adequate reversal requires information on which anticoagulant the patient has taken and when the last dose was ingested. Laboratory data can be of some help, but not for all anticoagulants in the emergency setting. This is reviewed here for the different types of anticoagulants: vitamin K antagonists, heparins, fondaparinux, thrombin inhibitors and factor Xa inhibitors. Specific antidotes for the latter are becoming available, but supportive care and nonspecific support for hemosta
Ключевые слова:
andexanet alfa; anticoagulant agent; antivitamin K; blood clotting factor 10a inhibitor; fondaparinux; heparin; idarucizumab; protamine sulfate; prothrombin complex; recombinant blood clotting factor 7a; thrombin inhibitor; tranexamic acid; vitamin K group; anticoagulant agent; antithrombin; blood clotting factor 10a inhibitor; heparin; vitamin K group; anticoagulant therapy; anticoagulation; bleeding; brain hemorrhage; drug antagonism; drug mechanism; early intervention; emergency health service; gastrointestinal hemorrhage; hemodialysis; human; international normalized ratio; nonhuman; plasma; priority journal; Review; bleeding; disease management; Anticoagulants; Antithrombins; Disease Management; Factor Xa Inhibitors; Hemorrhage; Heparin; Humans; Vitamin K
Piran S.
Shul`man S. Se`m 1952-
Пиран С.
Шульман С. Сэм 1952-
Treatment of bleeding complications in patients on anticoagulant therapy
Текст визуальный непосредственный
Blood
American Society of Hematology
Vol.133, Issue5 P. 425-435
2019
Обзор
andexanet alfa anticoagulant agent antivitamin K blood clotting factor 10a inhibitor fondaparinux heparin idarucizumab protamine sulfate prothrombin complex recombinant blood clotting factor 7a thrombin inhibitor tranexamic acid vitamin K group anticoagulant agent antithrombin blood clotting factor 10a inhibitor heparin vitamin K group anticoagulant therapy anticoagulation bleeding brain hemorrhage drug antagonism drug mechanism early intervention emergency health service gastrointestinal hemorrhage hemodialysis human international normalized ratio nonhuman plasma priority journal Review bleeding disease management Anticoagulants Antithrombins Disease Management Factor Xa Inhibitors Hemorrhage Heparin Humans Vitamin K
Anticoagulant therapy is often refrained from out of fear of hemorrhagic complications. The most frequent type of major bleeding is gastrointestinal, but intracranial hemorrhage has the worst prognosis. Management of these complications in patients on anticoagulants should follow the same routines as for nonanticoagulated patients, as described here with the previously mentioned bleeds as examples. In addition, for life-threatening or massive hemorrhages, reversal of the anticoagulant effect is also crucial. Adequate reversal requires information on which anticoagulant the patient has taken and when the last dose was ingested. Laboratory data can be of some help, but not for all anticoagulants in the emergency setting. This is reviewed here for the different types of anticoagulants: vitamin K antagonists, heparins, fondaparinux, thrombin inhibitors and factor Xa inhibitors. Specific antidotes for the latter are becoming available, but supportive care and nonspecific support for hemosta