SCCM Resource Library-Anticoagulation Reversal for Life-Threatening Bleeding: A Case-Based Presentation for the Critical Care Team

Video Transcription

Video Summary

Dr. Gregory Piazza, along with Dr. Tony Gutierrez and John Finikos, gives a presentation on anticoagulation reversal in critical care settings. They discuss the different approaches to reversing anticoagulation for medications like warfarin and direct oral anticoagulants. The speakers highlight the need to manage bleeding complications and standardize care for bleeding patients. They also stress the importance of identifying at-risk patient groups and assessing bleeding risk in those requiring anticoagulants. The presentation covers the pharmacology and clinical utility of specific anticoagulants and reversal agents. The speakers emphasize the importance of evidence-based approaches to anticoagulation reversal while avoiding overuse of expensive drugs. Case-based questions are used to engage the audience. The transcript also discusses the effectiveness of Andexanet-alpha, a reversal agent for factor Xa inhibitors. The Anexa-4 study found that Andexanet-alpha effectively reversed the anticoagulant effects of factor Xa inhibitors and resulted in most bleeding patients achieving hemostasis. However, the study showed that reversal of anti-Xa level did not always correlate with bleeding control, except in cases of intracranial hemorrhage. Safety results revealed some thromboembolic events, mainly due to the increased risk when patients were off anticoagulation. The transcript addresses the importance of developing protocols for managing bleeding in patients on anticoagulation therapy and the need for a multidisciplinary approach. It also mentions the challenges of cost and availability of reversal agents and suggests that insurance coverage should be considered. Overall, the presentation provides a comprehensive overview of anticoagulation reversal, focusing on individualized care and the use of Andexanet-alpha.

Asset Subtitle

Hematology, Pharmacology, 2020

Asset Caption

The Society of Critical Care Medicine's Critical Care Congress features internationally renowned faculty and content sessions highlighting the most up-to-date, evidence-based developments in critical care medicine. This is a presentation from the 2020 Critical Care Congress held February 16-19, 2020, in Orlando, Florida, USA.

This program is supported by an educational grant from Portola Pharmaceuticals

Learning Objectives

Appraise the risk of bleeding with DOAC therapy, describe the risk factors associated with bleeding, and examine strategies to mitigate these risks in order to improve patient and healthcare system outcomes
Differentiate between available and emerging novel, specific anticoagulation reversal agents; assessing their differences and similarities in mechanism of action; and review the latest clinical trial data and practical administration considerations
Evaluate the role of the critical care team in developing a protocol for implementation of novel anticoagulation reversal agents and design treatment strategies for patients with bleeding complications

Exploring the Clinical Implications of Bleeding: Appreciating the Burden and Risk Associated with Life-Threatening or Uncontrolled Bleeding

Jorge Antonio Gutierrez

The Emergence of Novel Anticoagulation Reversal Agents: An In-Depth Analysis for the Critical Care Team

Gregory Piazza

Ensuring Appropriate Use of Anticoagulation Reversal Agents: The Experts Weigh In

John Fanikos

Meta Tag

Content Type Presentation

Knowledge Area Hematology

Knowledge Area Pharmacology

Knowledge Level Intermediate

Knowledge Level Advanced

Membership Level Select

Membership Level Professional

Membership Level Associate

Tag Anticoagulation

Tag Blood and Blood Substitutes

Year 2020

Keywords

anticoagulation reversal

warfarin

direct oral anticoagulants

bleeding complications

standardize care

at-risk patient groups

reversal agents

evidence-based approaches

Andexanet-alpha

factor Xa inhibitors

Anexa-4 study

hemostasis

multidisciplinary approach

Hematology

Pharmacology

Anticoagulation

Presentation

Select

Professional

Associate

2020

Blood Blood Substitutes

Intermediate

Advanced

Blood and Blood Substitutes

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