If INR elevated, consider 10 mg IV vitamin K to exclude vitamin K deficiency.If ingested in Rapid reference for Xa-inhibitor reversal Dialysis may be considered if idarucizumab is unavailable.įactor Xa inhibitors (riveroXaBAN, apiXaBAN, edoXaBAN, fondaparinux).Due to its low percent protein binding, dabigatran can be removed by dialysis (whereas other DOACs cannot be).If idarucizumab is unavailable, four-factor PCC may be used as an alternative, second-line treatment.Little high-quality evidence is available regarding this drug.Side-effects may include hypokalemia, delirium, pyrexia, and bankruptcy.A small proportion of patients may have a rebound of dabigatran levels >12 hours after reversal due to drug redistribution out of adipose tissue, which may associate with bleeding.Follow PTT (or thrombin time if available) at baseline, 2-4 hours after idarucizumab, and 12-24 hours later.However, for patients with an unusually high level dabigatran (e.g., new-onset renal failure with drug accumulation), there is a possibility that additional doses might be needed. This is typically provided as two separate 2.5-gram doses no more than 15 minutes apart. A total of 5 grams is usually sufficient.□ For emergent reversal of anticoagulation, there is only one dose & one route of vitamin K that should be used: 10 mg IV vitamin K.PO administration has slower absorption.IM administration may cause hematoma formation.Subcutaneous administration has erratic absorption.Other routes are inferior for emergent reversal:.An anaphylactoid reaction is rate-related, so the likelihood of a severe adverse reaction at this slow of a rate is really zero. If you're absolutely terrified about this reaction, then infuse the vitamin K incredibly slowly (e.g.Fear of this reaction should never be a barrier to giving intravenous vitamin K to patients who need it.However, anaphylactoid reactions are generally less severe and can be avoided by infusing a drug slowly. Anaphylactoid reactions can present similarly to anaphylactic reactions and may be treated similarly. An anaphylactoid reaction is due to a drug's directly stimulating mast cells to release histamine – unlike an anaphylactic reaction, which involves IgE antibodies.This is an anaphylactoid reaction (not anaphylactic), so it can be avoided by infusing the vitamin K slowly (e.g., over 30 minutes).This is exceedingly rare (~1/30,000 patients).Intravenous vitamin K may theoretically cause an anaphylactoid response if infused rapidly. It takes Vitamin K 6-12 hours to start working, so vitamin K must be given simultaneously with FFP or PCC.
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