Novel Anticoagulation Options:Target-Specific Oral Agents an - Episode 12
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:
The risk of stroke is vastly underestimated, while the risk of bleeding is overestimated, said Ruff. Time is our friend, he said, with the novel oral anticoagulants, because almost all of the anticoagulant effect clears the patient’s system in about 24 hours for patients with relatively preserved renal function. So reversal should not be the first step; it should be stopping the drug and waiting, except in the case of life-threatening bleeds.
If a patient has recently taken a dose of anticoagulant therapy and is in a car accident with bleeding, Naccarelli advised giving the patient activated charcoal to decrease the drug’s absorption. After surgery, one of the ways to minimize bleeding is to reinitiate the anticoagulant when the patient has reached hemostasis rather than bridging them.