Biomaterial Database

Treatment of bleeding complications in patients on anticoagulant therapy. 2019

Siavash Piran, and Sam Schulman

Department of Medicine, Division of Hematology and Thromboembolism, and Thrombosis and Atherosclerosis Research Institute, McMaster University, Hamilton, Canada; and.

Anticoagulant therapy is often refrained from out of fear of hemorrhagic complications. The most frequent type of major bleeding is gastrointestinal, but intracranial hemorrhage has the worst prognosis. Management of these complications in patients on anticoagulants should follow the same routines as for nonanticoagulated patients, as described here with the previously mentioned bleeds as examples. In addition, for life-threatening or massive hemorrhages, reversal of the anticoagulant effect is also crucial. Adequate reversal requires information on which anticoagulant the patient has taken and when the last dose was ingested. Laboratory data can be of some help, but not for all anticoagulants in the emergency setting. This is reviewed here for the different types of anticoagulants: vitamin K antagonists, heparins, fondaparinux, thrombin inhibitors and factor Xa inhibitors. Specific antidotes for the latter are becoming available, but supportive care and nonspecific support for hemostasis with antifibrinolytic agents or prothrombin complex concentrates, which are widely available, should be kept in mind.

UI	MeSH Term	Description	Entries
D006470	Hemorrhage	Bleeding or escape of blood from a vessel.	Bleeding,Hemorrhages
D006493	Heparin	A highly acidic mucopolysaccharide formed of equal parts of sulfated D-glucosamine and D-glucuronic acid with sulfaminic bridges. The molecular weight ranges from six to twenty thousand. Heparin occurs in and is obtained from liver, lung, mast cells, etc., of vertebrates. Its function is unknown, but it is used to prevent blood clotting in vivo and vitro, in the form of many different salts.	Heparinic Acid,alpha-Heparin,Heparin Sodium,Liquaemin,Sodium Heparin,Unfractionated Heparin,Heparin, Sodium,Heparin, Unfractionated,alpha Heparin
D006801	Humans	Members of the species Homo sapiens.	Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000925	Anticoagulants	Agents that prevent BLOOD CLOTTING.	Anticoagulant Agent,Anticoagulant Drug,Anticoagulant,Anticoagulant Agents,Anticoagulant Drugs,Anticoagulation Agents,Indirect Thrombin Inhibitors,Agent, Anticoagulant,Agents, Anticoagulant,Agents, Anticoagulation,Drug, Anticoagulant,Drugs, Anticoagulant,Inhibitors, Indirect Thrombin,Thrombin Inhibitors, Indirect
D000991	Antithrombins	Endogenous factors and drugs that directly inhibit the action of THROMBIN, usually by blocking its enzymatic activity. They are distinguished from INDIRECT THROMBIN INHIBITORS, such as HEPARIN, which act by enhancing the inhibitory effects of antithrombins.	Antithrombin,Direct Antithrombin,Direct Antithrombins,Direct Thrombin Inhibitor,Direct Thrombin Inhibitors,Antithrombin, Direct,Antithrombins, Direct,Inhibitor, Direct Thrombin,Thrombin Inhibitor, Direct,Thrombin Inhibitors, Direct
D014812	Vitamin K	A lipid cofactor that is required for normal blood clotting. Several forms of vitamin K have been identified: VITAMIN K 1 (phytomenadione) derived from plants, VITAMIN K 2 (menaquinone) from bacteria, and synthetic naphthoquinone provitamins, VITAMIN K 3 (menadione). Vitamin K 3 provitamins, after being alkylated in vivo, exhibit the antifibrinolytic activity of vitamin K. Green leafy vegetables, liver, cheese, butter, and egg yolk are good sources of vitamin K.
D019468	Disease Management	A broad approach to appropriate coordination of the entire disease treatment process that often involves shifting away from more expensive inpatient and acute care to areas such as preventive medicine, patient counseling and education, and outpatient care. This concept includes implications of appropriate versus inappropriate therapy on the overall cost and clinical outcome of a particular disease. (From Hosp Pharm 1995 Jul;30(7):596)	Disease Managements,Management, Disease,Managements, Disease
D065427	Factor Xa Inhibitors	Endogenous factors and drugs that inhibit or block the activity of FACTOR XA.	Direct Factor Xa Inhibitor,Direct-Acting Oral Anticoagulant,Direct-Acting Oral Anticoagulants,Factor Xa Inhibitor,Direct Factor Xa Inhibitors,Anticoagulant, Direct-Acting Oral,Anticoagulants, Direct-Acting Oral,Direct Acting Oral Anticoagulant,Direct Acting Oral Anticoagulants,Inhibitor, Factor Xa,Oral Anticoagulant, Direct-Acting,Oral Anticoagulants, Direct-Acting,Xa Inhibitor, Factor