Abstract:
:An understanding of reversal strategies alone is important to safely and effectively care for patients in cases of bleeding or invasive procedures. The recent diversification in the number of licensed anticoagulants makes an understanding of drug-specific reversal strategies essential. Intravenous or oral vitamin K can reverse the effect of vitamin K antagonists (VKAs) within 12 to 48 hours and is indicated for any bleeding or an international normalized ratio >10 or 4.5 to 10 in patients with additional risk factors for bleeding. Furthermore, an additional administration of prothrombin complex concentrate (PCC) may be necessary in cases of major bleeding related to VKA. Protamine (chloride or sulfate) fully reverses the effect of unfractionated heparin and partially in low-molecular-weight heparin. Idarucizumab has been approved for dabigatran reversal, whereas andexanet alfa is approved for the reversal of some oral factor Xa inhibitors (apixaban, rivaroxaban). PCC seems to enhance the haemostatic potential for the reversal of the effect of FXa-inhibitors. So far, there are promising but only limited data on the efficacy of this approach available. Each reversal strategy needs an adequate management beyond the hemostatic treatment (volume replacement, stabilization of homeostasis, e.g., pH and temperature, resumption of anticoagulation after successful treatment of bleeding, etc.) that is crucial for the successful management of acute bleedings, urgent high-risk surgery, thrombolytic therapies or thrombectomies as well as overdosing of anticoagulants. :Das Verständnis für spezifische Reversierungsstrategien antikoagulierter Patienten ist wichtig, um einen Patienten sicher und effektiv bei Blutungen oder invasiven Prozeduren behandeln zu können. Auf Grund der Vielzahl von Antikoagulanzien ist das Wissen um spezifische Reversierungsstrategien essentiell. Intravenös oder oral verabreichtes Vitamin K kann die Wirkung von Vitamin-K-Antagonisten (VKA) innerhalb von 12 bis 48 Stunden reversieren und ist bei jeder Blutung, bei einer international normalized ratio (INR) > 10 oder einer INR von 4,5 bis 10 und weitere Risikofaktoren für Blutungen, indiziert. Zusätzlich kann eine Gabe von Prothrombin-Komplex-Konzentraten (PPSB) bei großen Blutungen unter VKA erforderlich werden. Protamin(-chlorid oder -sulfat) heben die Wirkung von unfraktioniertem Heparin (UFH) vollständig und niedermolekularem Heparin (NMH) partiell auf. Idarucizumab ist zugelassen für die Reversierung von Dabigatran, während Andexanet alfa für die Reversierung einiger oraler Faktor Xa Inhibitoren (Rivaroxaban, Apixaban) bedingt zugelassen ist. PPSB scheint eine Erhöhung des hämostatischen Potenzials zu bewirken, welches einen der Reversierung der FXa-Inhibitoren ähnlichen Effekt aufweist. Zur Effektivität dieser Therapie sind bislang viel versprechende, aber insgesamt nur wenige Daten vorhanden. Jede Reversierungsstrategie benötigt ein über die Aufhebung der Antikoagulation hinausgehendes Management (Volumenersatz, Aufrechterhaltung der Homöostase, z.B. pH, Temperatur, Wiederbeginn der Antikoagulation nach erfolgreicher Therapie der Blutung, etc.), welches für die erfolgreiche Behandlung akuter Blutungen, dringender Operationen mit hohem Risiko, avisierter Thrombolysen oder Thrombektomien sowie Antikoagulanzienüberdosierungen unerlässlich ist.
journal_name
Hamostaseologiejournal_title
Hamostaseologieauthors
Koscielny J,Rutkauskaite E,Sucker C,von Heymann Cdoi
10.1055/a-1113-0557subject
Has Abstractpub_date
2020-06-01 00:00:00pages
201-213issue
2eissn
0720-9355issn
2567-5761journal_volume
40pub_type
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