Oral anticoagulant therapy reduces the risk of thromboembolic events in a wide variety of patient groups. The aging population, coupled with increasing evidence for efficacy and ease of use of new oral anticoagulants, has lead increasing numbers of patients to require anticoagulation. Unfortunately, patients receiving oral anticoagulants suffer complications including bleeding and the need for interruption around the time of procedures. This session will focus on strategies to reverse both vitamin K antagonists and the newer direct oral anticoagulants using current evidence and recently approved products available in the United States.
Warfarin remains one of the most widely used oral anticoagulants and despite more than 60 years of use clinicians continue to struggle to manage its anticoagulant effects particularly in patients requiring acute normalization of their coagulation status.
Dr. Eichinger will discuss an approach involving a systematic evaluation of the patient, and the use of both direct and indirect strategies to correct the anticoagulant effect of the oral vitamin K antagonists.
Dr. Crowther will discuss recent advances in bridging both vitamin K antagonists and new oral anticoagulants using both non-specific, and specific reversal strategies and will discuss recent “up-to-the-minute evidence for the use of idarucizumab and andexanet.”
Patients who suffer bleeding complications or who undergo surgery require careful control of their oral anticoagulant therapy. Failing to appropriately restart anticoagulants is associated with death and avoidable thromboembolism; early restart is associated with hemorrhage which has direct toxicity and which may delay reinstitution causing a paradoxical increase in the risk of thromboembolism.
Dr. Witt will discuss strategies to restart anticoagulation to mitigate the risk of both bleeding and thromboembolism.