Study 7 Reversal Agents and Bleeding Management with 12 free online flashcards. Review key terms, definitions, and concepts with this interactive flashcard deck.
What is preferred for life-threatening warfarin-associated bleeding?
Stop warfarin and give four-factor prothrombin complex concentrate (4F-PCC) plus intravenous vitamin K. PCC rapidly replaces clotting factors, while vitamin K supports their continued production.
What is a commonly used U.S. approach to severe apixaban-associated bleeding?
In the United States, andexanet alfa is no longer manufactured or sold; commercial sales ended December 22, 2025. 4F-PCC is commonly used under institutional protocols when significant drug effect is likely.
Which specific reversal agent and dose are used for major dabigatran bleeding?
Give idarucizumab 5 g intravenously as two 2.5-g doses. It specifically binds dabigatran.
What reverses unfractionated heparin?
Protamine can rapidly neutralize unfractionated heparin.
Should platelets routinely be transfused for aspirin-associated intracranial hemorrhage without emergency surgery?
No. For spontaneous intracranial hemorrhage without emergency surgery, platelet transfusion may be harmful and should not be given routinely.
Can a normal routine clotting test rule out significant direct oral anticoagulant activity?
A normal routine clotting test does not rule out clinically important direct oral anticoagulant activity.
What are core immediate steps for suspected life-threatening bleeding?
Urgently stop the causative antithrombotic when appropriate, stabilize airway, breathing, and circulation, control the bleeding source, and obtain needed blood products and specialist support.
What is an alternative to 4F-PCC for warfarin reversal?
Plasma may be used if 4F-PCC is unavailable.
What is an important limitation of 4F-PCC for apixaban bleeding?
4F-PCC is nonspecific: it does not bind or remove apixaban, and it can increase thrombotic risk.
Why reassess for recurrent anticoagulant effect after dabigatran reversal in renal impairment?
Impaired kidney function may prolong dabigatran exposure. Reassess for recurrent anticoagulant effect using the clinical picture and relevant coagulation tests.
How should protamine be administered for unfractionated heparin reversal?
Calculate the protamine dose from the amount of heparin given recently and administer it slowly; rapid infusion can cause severe hypotension or anaphylactoid reactions.
How completely does protamine reverse enoxaparin?
Protamine reverses enoxaparin only partially; anti-factor Xa activity may remain.
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