Management of major bleeding for anticoagulated patients in the Emergency Department: an European experts consensus statement.

Backus, Barbra; Beyer-Westendorf, Jan; Body, Rick; Lindner, Tobias; Möckel, Martin; Sehgal, Vinay; Parry-Jones, Adrian; Seiffge, David; Gibler, Brian (2023). Management of major bleeding for anticoagulated patients in the Emergency Department: an European experts consensus statement. European journal of emergency medicine, 30(5), pp. 315-323. Wolters Kluwer Health 10.1097/MEJ.0000000000001049

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An increasing number of patients presenting to the emergency department (ED) with life-threatening bleeding are using oral anticoagulants, such as warfarin, Factor IIa and Factor Xa inhibitors. Achieving rapid and controlled haemostasis is critically important to save the patient's life. This multidisciplinary consensus paper provides a systematic and pragmatic approach to the management of anticoagulated patients with severe bleeding at the ED. Repletion and reversal management of the specific anticoagulants is described in detail. For patients on vitamin K antagonists, the administration of vitamin K and repletion of clotting factors with four-factor prothrombin complex concentrate provides real-time ability to stop the bleeding. For patients using a direct oral anticoagulant, specific antidotes are necessary to reverse the anticoagulative effect. For patients receiving the thrombin inhibitor dabigatran, treatment with idarucizamab has been demonstrated to reverse the hypocoagulable state. For patients receiving a factor Xa inhibitor (apixaban or rivaroxaban), andexanet alfa is the indicated antidote in patients with major bleeding. Lastly, specific treatment strategies are discussed in patients using anticoagulants with major traumatic bleeding, intracranial haemorrhage or gastrointestinal bleeding.

Item Type:

Journal Article (Review Article)

Division/Institute:

04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology

UniBE Contributor:

Seiffge, David Julian

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1473-5695

Publisher:

Wolters Kluwer Health

Language:

English

Submitter:

Pubmed Import

Date Deposited:

10 Jul 2023 16:54

Last Modified:

09 Jul 2024 00:25

Publisher DOI:

10.1097/MEJ.0000000000001049

PubMed ID:

37427548

BORIS DOI:

10.48350/184632

URI:

https://boris.unibe.ch/id/eprint/184632

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