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If aPTT is persistently elevated, repeat 0.5 mg/100 units Low-Molecular Weight Heparin 13 Alternatively, can give fixed dose of 25-50mg.Protamine sulfate 1mg/100 units IV, maximum dose 50mg.Unfractionated Heparin Dosingĭetermination of units of heparin is based on estimated active agent (half-life 1-2 hours)

If idarucizumab is not available, aPCC (50-80 units/kg), 4F-PCC or 3F-PCC (50 units/kg) can be used in order of preference. If ongoing significant bleeding after treatment, consider redosing idarucizumab and/or hemodialysis. Use high-dose Andexanet alfa regimen 12 Direct Thrombin inhibitors (ex.

High-dose: If greater than above thresholds, or dose/timing unknown.

Low-dose: rivaroxaban <10mg, apixaban <5mg, edoxaban <30mg or 8 or more hours since last dose.

rivaroxaban, apixaban)Īctivated charcoal may be effective for up to six hours for apixaban 7 and eight hours for rivaroxaban 8.

4F-PCC: May consider repeat PCC dosing based on INR, though with increased DIC and thrombotic risk, it is recommended to correct further with FFP if INR remains ≥1.4 6ĭirect Factor Xa Inhibitors (ex.

Follow local institution guidelines if available. warfarin) Initial DoseĪ fixed dose of 4F-PCC 1500 to 2000 units can be given as an initial dose with repeat dosing based on INR measurement 15 minutes after completion of infusion. Use cautiously in patients with concomitant life-threatening ischemia, thrombosis, or severe DIC.

Avoid reversal for intracranial hemorrhage associated with cerebral venous thrombosis.

Patients may require blood pressure control including anti-hypertensive infusions (goal SBP <140). An Algorithm for the Reversal of Anticoagulation for Intracranial Hemorrhage 1-4įor all agents, discontinue anticoagulation. The patient is taken emergently to the operating room by neurosurgery for craniotomy and hematoma evacuation. Andexanet Alfa is not available, therefore an infusion of 4-Factor PCC is initiated. From the case rID: 32395Ī nicardipine infusion is initiated and the head of the bed is elevated. Left cerebral convexity acute subdural hematoma producing substantial mass effect with midline shift and left uncal herniation.Ĭase courtesy of Dr Andrew Dixon,.