Reversal of Anticoagulants

Millions of patients worldwide are treated with anticoagulant therapy and physicians can choose among a variety of oral and parenteral anticoagulants which makes reversal strategies in emergency situations a challenge.This textbook will offer detailed insights into the pharmacological concepts of anticoagulation reversal. It provides a short overview on the physiology of the blood coagulation system and reviews the impact of anticoagulants and bleeding on the coagulation system in humans. Furthermore, the pharmacological profile and mode of action will be carefully reviewed, separately for all classes of oral or parenteral anticoagulants. Moreover, the incidence and severity of bleeding emergencies during anticoagulant therapy and the interpretation of laboratory values in the setting of anticoagulation-related bleeding will be discussed. Finally, detailed recommendations for reversal strategies will be provided, depending on the underlying individual situation.

1.Introduction to anticoagulation reversal102.Physiology of hemostasis123.Pharmacological profile of anticoagulants164.Effects of anticoagulants on hemostasis in relation to the associatedbleeding risk205.Bleeding risk factors increasing the impact of anticoagulants246.General considerations on “when to consider reversal”327.Reversal of unfractionated heparin, low molecular weight heparinheparinoids and fondaparinux368.Reversal of vitamin K antagonists (VKA)429.Reversal of non-vitamin K dependent, direct oral anticoagulants4810.Future research and development of anticoagulation reversal6211.Abbreviations6812.References70Index80