How is major hemorrhage in patients on oral anticoagulants treated?
For warfarin, and all the NOACs, 4-factor prothrombin complex concentrate rather than fresh frozen plasma is recommended for reversing anticoagulation in acute life-threatening hemorrhages.
Anti-fibrinolytic agents, such as tranexamic acid and epsilon-aminocaproic acid, may also be used.
For warfarin-associated bleeding, intravenous vitamin K can be used concomitantly.
As for dabigatran, idarucizumab is a humanized anti-dabigatran monoclonal antibody fragment that is effective for emergency reversal.
Hemodialysis has also been used to clear dabigatran, but it is not suitable for factor Xa inhibitors.
