Anticoagulant Reversal Strategies in the Emergency Department Setting: Recommendations of a Multidisciplinary Expert Panel

Bleeding is the most common complication of anticoagulant use. The evaluation and management of the bleeding patient is a core competency of emergency medicine. As the prevalence of patients receiving anticoagulant agents and variety of anticoagulants with different mechanisms of action, pharmacokin...

Full description

Saved in:

Bibliographic Details
Published in:	Annals of emergency medicine Vol. 76; no. 4; pp. 470 - 485
Main Authors:	Baugh, Christopher W., Levine, Michael, Cornutt, David, Wilson, Jason W., Kwun, Richard, Mahan, Charles E., Pollack, Charles V., Marcolini, Evie G., Milling, Truman J., Peacock, W. Frank, Rosovsky, Rachel P., Wu, Fred, Sarode, Ravi, Spyropoulos, Alex C., Villines, Todd C., Woods, Timothy D., McManus, John, Williams, James
Format:	Journal Article
Language:	English
Published:	United States Elsevier Inc 01.10.2020
Subjects:	Anticoagulants - administration & dosage Anticoagulants - therapeutic use Consensus Drug Antagonism Emergency Emergency Service, Hospital - organization & administration Emergency Service, Hospital - statistics & numerical data Hemorrhage - drug therapy Humans
ISSN:	0196-0644, 1097-6760, 1097-6760
Online Access:	Get full text
Tags:	Add Tag No Tags, Be the first to tag this record!

Description
Summary:	Bleeding is the most common complication of anticoagulant use. The evaluation and management of the bleeding patient is a core competency of emergency medicine. As the prevalence of patients receiving anticoagulant agents and variety of anticoagulants with different mechanisms of action, pharmacokinetics, indications, and corresponding reversal agents increase, physicians and other clinicians working in the emergency department require a current and nuanced understanding of how best to assess, treat, and reverse anticoagulated patients. In this project, we convened an expert panel to create a consensus decision tree and framework for assessment of the bleeding patient receiving an anticoagulant, as well as use of anticoagulant reversal or coagulation factor replacement, and to address controversies and gaps relevant to this topic. To support decision tree interpretation, the panel also reached agreement on key definitions of life-threatening bleeding, bleeding at a critical site, and emergency surgery or urgent invasive procedure. To reach consensus recommendations, we used a structured literature review and a modified Delphi technique by an expert panel of academic and community physicians with training in emergency medicine, cardiology, hematology, internal medicine/thrombology, pharmacology, toxicology, transfusion medicine and hemostasis, neurology, and surgery, and by other key stakeholder groups.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 Authorship: All authors attest to meeting the four ICMJE.org authorship criteria: (1) Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND (2) Drafting the work or revising it critically for important intellectual content; AND (3) Final approval of the version to be published; AND (4) Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved
ISSN:	0196-0644 1097-6760 1097-6760
DOI:	10.1016/j.annemergmed.2019.09.001