- Home
- Welcome and Orientation
- About This Guide
- Patient Transfers
- AAA
- Anticoagulation Reversal
- ARDS/Mechanical Vent
- Atrial Fibrillation
- Brain Death
- CAR-T
- Crash Cart/Defibrillator
- CSW/SIADH
- Cricothyrotomy
- Cuff Leak. What is it?
- Delirium/Antipsychotics
- DKA/Other Ketoacidosis
- EVD AND ICP MONITORS
- ETOH Withdrawal
- Extubation Readiness
- Febrile Neutropenia
- Fluids
- GI Bleeds
- Group A Streptococcus
- Hypertension PRNs
- Lido With Epi Recipe
- Lines & Tubes on CXR
- Lumbar Drains
- Lung Volume Recruitment
- Massive Transfusion
- O2 Delivery Devices
- Pacemaker Insertion
- Pain/Analgesia
- Pocket Pressor Recipes
- Pulmonary Embolism/PERT
- Respiratory Failure
- ROSC
- Sedation in ICU
- Seizures/Status
- Shock and Sepsis
- Subarachnoid Hemorrhage
- Swan Ganz Catheter Setup
- TBI/EVD/ICP monitoring
- TEVAR
- Toxicology/Overdose
- Tracheostomies AND THT
- Trauma Patients in ICU
- Tumor Lysis Syndrome
- Vasoactive Medications
- Ultrasound Guided Lines
Anticoagulation Reversal
Where the Anticoagulants Work in the Coagulation Cascade
Clopidogrel
Mechanism of Action
- Platelet inhibition
- Glycoprotein GPIIb/IIIa complex inhibitor
Measure
- None
Reversal
- 2-3 Units of pooled platelets
- Tranexamic Acid 1g every 8 hours or by infusion
Dabigatran
Mechanism of Action
- Direct Thrombin Inhibitor
Measure
- PTT, dTT
Reversal
- Idarucizumab 5g IV over 5-10 minutes
DOAC's
Mechanism of Action
- Inhibit activation of Factor Xa
Measure
- Measure anti-Xa for specific drug
Reversal
- Prothrombin Complex Concentrate (PCC/Octaplex) 2000 Units IV
Fondarinux
Mechanism of Action
- ATIII-mediated selective inhibition of Factor Xa.
- Selectively bindis to ATIII to potentiate the neutralization of Factor Xa by ATIII.
Measure
- anti-Xa activity for Fondaparinux
Reversal
- PCC 2000 Units IV
- Recombinant aFVII
LMWH
Mechanism of Action
- Activation of Antithrombin III
Measure
- Measure anti-Xa for unfractionated Hpearin
Reversal
- Protamine 1mg/1mg of Enoxaparin ((precise answer)
- Protamine 1mg/10mg Danaparoid (precise answer)
- Most commonly we administer 50mg IV slowly over 10 minutes
- Binds to Heparin to form a salt
- May need repeated dosing
Side Effects
- Can cause an anaphylactoid reaction (hypotension)
- Bronchospasm
- Pulmonary Hypertesion
Ticagrelor
Mechanism of Action
- Platelet Inhibitor
- Inhibits the platelet P2Y12 receptor
Measure
- None
Reversal
- 2-3 Units of pooled platelets
- Tranexamic Acid 1g every 8 hours or by infusion
Unfractionated Heparin
Mechanism of Action
- Activation of Antithrombin III
Measure
- Measure anti-Xa for unfractionated Hpearin
Reversal
- Protamine 1mg/100 Units of Heparin (precise answer)
- Most commonly we administer 50mg IV slowly over 10 minutes
- Binds to Heparin to form a salt
Side Effects
- Can cause an anaphylactoid reaction (hypotension)
- Bronchospasm
- Pulmonary Hypertesion
Warfarin
Mechanism of Action
- Antagonist of Vitamin K dependent clotting factors (II, VII, IX, X, and Protein C, Protein S, Antithrombin III)
Measure
- INR
Reversal
- Vitamin K 10mg IV x 1
- PCC (see dosing table below)
pcc dosing table for warfarin
