Archive for the ‘coagulopathy’ Category

Emergent anticoagulation reversal

November 26th, 2009
by reuben in coagulopathy

Many recommendations, little science. Rob Orman ERCAST Reversal Guide EBM EMCC Coagulopathy Reversal   Excerpted from MSSM M&M teaching points: * Head-injured patients who are anticoagulated are at risk for delayed intracranial bleeding after a negative head CT. Options for managing this risk include a period of ED observation, admission to the hospital, and discharge with strict precautions/supervision (with or without a scheduled return visit). These strategies may or may not be combined with a repeat head CT. The duration of increased risk is not known but is thought to be somewhere between 24-72 hours, though delayed bleeds have presented even later than this. * Intracranial bleeding with coagulopathy is a medical and surgical emergency that is both immediately life-threatening and responsive to ED therapies. These therapies should not wait for consultant collaboration and, where suspicion of ICH is sufficient, initiation of these therapies should not wait until confirmation of ICH. * For patients with life-threatening bleeding on warfarin: administer vitamin K 10mg IV over 10 minutes and prothrombin complex concentrate. Dosing of PCC is not firmly established and can be based on both weight and INR, but 50 units/kg is a reasonable starting point in an emergency. An alternative is FFP, which should be administered at a dose of 15 ml/kg. At Sinai, a unit of FFP contains anywhere between 150 and 350 cc FFP; assume 200 cc for estimation purposes. FFP is blood type-specific; the blood bank needs to know the patient’s blood type but does not need a blood sample to cross-match….

the second “prothrombin time” should be “partial thromboplastin time”