Summary

Supratherapeutic INRs and overanticoagulation leading to clinically significant bleeding are problems commonly encountered by the emergency physician. In order to effectively diagnose and manage these problems, the emergency physician must be well versed in anticoagulants frequently used and the antidotes used to treat their overuse.

While vitamin K, FFP, and protamine have been the mainstay of anticoagulant correction to date, many new therapies such as prothrombin complex concentrates and recombinant activated factor VII hold promise in improving the outcomes of patients who require emergent reversal of their anticoagulant therapy.

References

1. Leissinger CA, Blatt PM, Hoots WK, et al. Role of prothrombin complex concentrates in reversing warfarin anticoagulation: A review of the literature. Am J Hematol. 2008;83:137-43.
2. Vigue B. Bench-to-bedside review: Optimising emergency reversal of vitamin K antagonists in severe haemorrhage—from theory to practice. Crit Care. 2009;13:209.
3. Weber JE, Jaggi FM, Pollack, CV. Anticoagulants, antiplatelet agents, and fibrinolytics. In: Tintinalli JE, Kelen GD, Stapczynski JS, eds. Emergengy Medicine: A Comprehensive Study Guide. 6th ed. McGraw-Hill; 2004: 1354-60.
4. Hirsh J, Guyatt G, Albers GW, et al. Executive Summary: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2008;133:72S-3S.
5. Hirsh J, Bauer KA, Donati MB, et al. Parenteral Anticoagulants. Chest 2008;133:147S-50S.

Contributor Disclosures

Contributors

Dr. Mathew is a third-year resident at the University of Chicago emergency medicine residency program. Dr. Kumar is chair and medical director of the department of emergency medicine at Community Hospital in Munster, Ind., and clinical instructor at University of Chicago Medical Center and Northwestern Memorial Hospital. Medical Editor Dr. Robert C. Solomon is an attending emergency physician at Trinity Health System in Steubenville, Ohio, and clinical assistant professor of emergency medicine at the West Virginia School of Osteopathic Medicine.

Disclosures

In accordance with the Accreditation Council for Continuing Medical Education (ACCME) Standards and American College of Emergency Physicians policy, contributors and editors must disclose to the program audience the existence of significant financial interests in or relationships with manufacturers of commercial products that might have a direct interest in the subject matter.

Dr. Mathew, Dr. Kumar, and Dr. Solomon have disclosed that they have no significant relationships with or financial interests in any commercial companies that pertain to this educational activity.

“Focus On: Reversal of Anticoagulation” has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education (ACCME).