Episode Chapters
- Ureteral Colic17:22Asymptomatic HypertensionFree Chapter17:29Paper Chase #1 | iPhone Otoscopy Outperforms Traditional Otoscope5:15Sacral PainFree Chapter18:50SVC Syndrome17:11Paper Chase #2 | Acetaminophen Prevents Recurrence Of Febrile Seizure3:38What Would I Do Next? | Pancreatitis20:47Fast Track Pearls20:09Paper Chase #3 | Don’t Give Opioids For Ankle Sprains!5:39Child Abuse18:34DOAC Reversal20:27Hyperkalemia16:01Paper Chase #4 | Risk Of Biphasic Anaphylactic Reactions Is Low3:49Excellence in the Physical Exam Series: Alcoholics11:46Paper Chase #5 | Don’t Miss Pediatric Anaphylaxis4:46The Summary13:02
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?
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
Chad K. - April 17, 2019 1:15 PM
How about TXA when your rural hospital does not have PCC, Kcentra?
Mike W., MD - April 17, 2019 3:10 PM
I will defer this question to the speakers and we will get back to you soon! Thx for the question!!
Mike W., MD - April 19, 2019 6:50 AM
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