PMID- 12557411
OWN - NLM
STAT- MEDLINE
DCOM- 20030407
LR  - 20131121
IS  - 0832-610X (Print)
IS  - 0832-610X (Linking)
VI  - 49
IP  - 6
DP  - 2002 Jun-Jul
TI  - Reversing anticoagulants both old and new.
PG  - S11-25
AB  - PURPOSE: Reversal of pharmacologic anticoagulation is an issue that arises when 
      an anticoagulated patient has major bleeding or when a patient on chronic 
      anticoagulant therapy requires urgent reversal of anticoagulation, for example, 
      for surgery. SOURCE: We reviewed the literature to determine what strategies are 
      available to reverse anticoagulation caused by older agents, such as warfarin or 
      unfractionated heparin (UFH), as well as newer agents, for example, 
      low-molecular-weight heparin, danaparoid, fondaparinux, lepirudin, and 
      argatroban. PRINCIPAL FINDINGS: Specific "antidotes" exist for the "classic" 
      anticoagulant agents: protamine sulfate for UFH, and vitamin K for warfarin. 
      However, vitamin K only begins to reverse warfarin's anticoagulant effect by four 
      to six hours, so urgent situations additionally require blood products, such as 
      plasma (fresh frozen or cryosupermatant plasma), prothrombin complex 
      concentrates, or, possibly, recombinant factor VIIa. A growing problem arises 
      from the increasing use of new anticoagulants that lack specific antidotes. For 
      example, protamine sulfate reverses only about 60% of the anti-factor Xa activity 
      of low-molecular-weight heparin, has negligible effects on danaparoid (a mixture 
      of anticoagulant glycosaminoglycans used to treat heparin-induced 
      thrombocytopenia) and fondaparinux (a novel synthetic antithrombin-binding 
      pentasaccharide with exclusive anti-factor Xa activity approved in the United 
      States for antithrombotic prophylaxis following orthopedic surgery). The new 
      direct thrombin inhibitors (e.g., lepirudin, bivalirudin, argatroban) also have 
      no specific antidote. CONCLUSION: Newer anticoagulant agents generally lack 
      specific antidotes. Thus, careful choice of an anticoagulant agent and laboratory 
      monitoring where appropriate are needed to minimize risk of bleeding 
      complications.
FAU - Warkentin, Theodore E
AU  - Warkentin TE
AD  - Department of Pathology and Molecular Medicine, McMaster University, Hamilton 
      Regional Laboratory Medicine Program, Hamilton Health Sciences, Hamilton, 
      Ontario, Canada.
FAU - Crowther, Mark A
AU  - Crowther MA
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PT  - Review
PL  - United States
TA  - Can J Anaesth
JT  - Canadian journal of anaesthesia = Journal canadien d'anesthesie
JID - 8701709
RN  - 0 (Anticoagulants)
RN  - 0 (Blood Coagulation Factors)
RN  - 0 (Protamines)
RN  - 12001-79-5 (Vitamin K)
RN  - 37224-63-8 (prothrombin complex concentrates)
RN  - 5Q7ZVV76EI (Warfarin)
RN  - EC 3.4.21.21 (Factor VIIa)
RN  - EC 3.4.21.5 (Thrombin)
SB  - IM
MH  - Anticoagulants/*antagonists & inhibitors/pharmacology
MH  - Blood Coagulation Factors/pharmacology
MH  - Factor VIIa/pharmacology
MH  - Humans
MH  - Protamines/pharmacology
MH  - Thrombin/antagonists & inhibitors
MH  - Vitamin K/pharmacology
MH  - Warfarin/adverse effects/antagonists & inhibitors/pharmacology
RF  - 98
EDAT- 2003/02/01 04:00
MHDA- 2003/04/08 05:00
CRDT- 2003/02/01 04:00
PHST- 2003/02/01 04:00 [pubmed]
PHST- 2003/04/08 05:00 [medline]
PHST- 2003/02/01 04:00 [entrez]
PST - ppublish
SO  - Can J Anaesth. 2002 Jun-Jul;49(6):S11-25.