Managing Bleeds Today: Keep It Simple

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The MD Magazine Peer Exchange “Novel Anticoagulation Options: Target-Specific Oral Agents and Their Antidotes” features leading physician specialists discussing key topics in anticoagulation therapy, including the clinical characteristics of current and emerging agents and criteria for use in specific patient populations.

This Peer Exchange is moderated by Peter Salgo, MD, professor of medicine and anesthesiology at Columbia University and an associate director of surgical intensive care at the New York-Presbyterian Hospital in New York City.

The panelists are:

• Scott Kaatz, DO, MSc, Chief Quality Officer at Hurley Medical Center in Flint, Michigan, and clinical associate professor at Michigan State University
• Seth Bilazarian, MD, clinical and interventional cardiologist at Pentucket Medical and instructor of medicine at Harvard Medical School
• Gerald Naccarelli, MD, Bernard Trabin Chair in Cardiology, professor of medicine and chief of the Division of Cardiology at Penn State University School of Medicine, and associate clinical director at Penn State Heart and Vascular Institute in Hershey, Pennsylvania
• Christian T. Ruff, MD, associate physician in the cardiovascular medicine division at Brigham and Women’s Hospital, and assistant professor of medicine at Harvard Medical School in Boston

Before using something very expensive and that might not work like factor VII to reverse anticoagulation, Naccarelli advised to consult a hematologist. In addition, Kaatz reminded the panel that it is important not to panic and give a prothrombotic agent to a patient for whom you are trying to prevent clotting. These patients are on anticoagulants for a reason, so that effect should not be reversed unless absolutely necessary.

The simplest strategy, said Ruff, regardless of which anticoagulant the patient is using, including warfarin, is to stop the drug, give a transfusion where warranted, have surgical hemostasis, and consult a hematologist early. And a PCC is a good option for all of the agents if reversal is needed, and vitamin K could help the patients on warfarin.