The clotting cascade, particularly in the context of anti-coagulation reversal can be complex to understand. Unfortunately, many of our patients are on anti-coagulation agents that require reversal in the presence of life-threatening hemorrhage. How do we choose the most appropriate agent based on which step of the coagulation cascade that it antagonizes? And when is it time to pull the trigger on doing so? In this podcast episode, we discuss this intense topic.
- Make thoughtful choices about who you anti-coagulate, because there is a downside to it.
- No matter what reversal agent you have, it does not un-bleed anything.
- Administer Vitamin K for Vitamin K antagonists (e.g., Coumadin).
- Administer K-Centra (Four-Factor PCC) for Coumadin and Factor Xa inhibitors.
- Don’t forget about simple things like compressible sites.