There are some alternative tests that can provide qualitative evidence that the drug is effective in producing some degree of anticoagulation, but the results are variable and may not clearly indicate the extent of that effect. Although certain tests for monitoring DOAC-induced anticoagulation have been found to show a good linear dose-dependent relationship, these are often unavailable at smaller hospitals. Table 3 outlines both preferred and alternative testing methods for many of the anticoagulants that might be encountered. Assessing Degree of AnticoagulationĪlthough none of the new oral anticoagulants require routine laboratory monitoring, an ability to monitor these agents could be useful in emergency situations such as acute bleeding or overdoses. A secure knowledge of which DOAC is involved and the timing and extent of the dosing is critical in guiding medical decisions regarding laboratory testing and treatment countermeasures.
It is also important for EMS personnel to familiarize themselves with both the generic and trade names of these therapies because the patient and family members will not always know the difference. The indications for the different DOACs as well as their characteristics, as listed in Table 1, Table 2, may help in determining which one is being used in any particular case. Therefore, it is incumbent on EMS personnel to capture this information if possible before leaving the scene of transport. In transport situations, this information may only be available at the primary site, especially if the patient is incapacitated and the family does not travel to the destination hospital. Because air medical personnel are increasingly likely to encounter patients receiving DOACs, it is important that they have an understanding of how to manage patients with emergent bleeding.Īn identification of the specific DOAC used, the patient’s prescribed dosing, amount ingested, and the time that the last dosage was taken can be important in the emergent management of these patients. This review aims to describe the indications and pharmacokinetics of available DOACs to discuss the risk of bleeding to provide a treatment algorithm to manage DOAC-associated emergency bleeding and to discuss future directions in bleeding management, including the role of specific reversal agents, such as the recently approved idarucizumab for reversal of the direct thrombin inhibitor dabigatran. The long-term use of these drugs is increasing, and there is a crucial need for emergency medicine service professionals to understand the optimal management of associated bleeding. As with all anticoagulants, bleeding, either spontaneous or provoked, is the most common complication. Direct oral anticoagulants (DOACs) offer clinical advantages over warfarin, such as minimal medication and food interactions and fixed dosing without the need for routine monitoring of coagulation status.
0 kommentar(er)
