Start with a free account for 3 free CME credits. Already a subscriber? Sign in.

DOAC Reversal

Tarlan Hedayati, MD, Neda Frayha, MD, and Matthieu DeClerck, MD
00:00
20:27
Sign in or subscribe to listen

No me gusta!

The flash player was unable to start. If you have a flash blocker then try unblocking the flash content - it should be visible below.

Continuing the recent discussion between Matt DeClerck and Dr. Tom Deloughery on the direct oral anticoagulants (DOACs), this month we bring you a segment on reversing these DOACs with Matt, Neda, and Dr. Tarlan Hedayati. What are the agents currently on the market, including the newest kid on the block, andexanet alfa? What does the evidence show about their safety and efficacy?

To view chapter written summaries, you need to subscribe.

Sign up today for full access to all episodes.

Chad K. -

How about TXA when your rural hospital does not have PCC, Kcentra?

Mike W., MD -

I will defer this question to the speakers and we will get back to you soon! Thx for the question!!

Mike W., MD -

The short answer is: Yes! TXA has a role if you have nothing else. However, it’s important to understand why it’s not enough.
The DOACs work to inhibit Factor Xa (xabans) or IIa (dabigatran). By inhibiting these, they prevent fibrin/clot formation. PCCs/FEIBA have factor II, VII, IX, and X. By adding back these factors during a bleed, you overwhelm the DOAC so the patient’s coagulation cascade can function normally and form the fibrin clot.
TXA works by inhibiting plasminogen such that it cannot break down clot, thereby allowing for the clot to remain stable. So....TXA does nothing to help form the clot. It just prevents its degradation. The patient has to be able to form the clot in the first place for TXA to have any effect. This is why you need the PCCs/FEIBA as well.
I hope that makes sense!
Tarlan

Tarlan Hedayati, MD, FACEP
Assistant Professor
Chair of Education
Department of Emergency Medicine
Cook County Health

To join the conversation, you need to subscribe.

Sign up today for full access to all episodes and to join the conversation.

To download files, you need to subscribe.

Sign up today for full access to all episodes.
No...You Aren't Gonna Die! Full episode audio for MD edition 226:23 min - 106 MB - M4AUC RAP February 2019 Written Summary 353 KB - PDF

To earn CME for this chapter, you need to subscribe.

Sign up today for full access to all episodes and earn CME.

0.25 Free AMA PRA Category 1 Credits™ certified by Hippo Education

  1. Complete Quiz
  2. Complete Evaluation
  3. Print Certificate

3.25 AMA PRA Category 1 Credits™ certified by Hippo Education

  1. Complete Quiz
  2. Complete Evaluation
  3. Print Certificate