Podcast 203 – New Reversals for New Anticoagulants with Nadia Awad - a podcast by Scott D. Weingart, MD FCCM

This stuff is not sexy and frankly, it hurts my head. That is all the more reason to do a show on the new landscape of NOAC reversal. We must pursue rather than avoid the subjects we are weak on. But I needed someone far smarter than myself--I needed a EM PharmD. Nobody better to speak about this topic than Nadia Awad. Nadia is associate editor of the Emergency Medicine PharmD Blog. She is an Emergency Medicine Pharmacist at the Robert Wood Johnson University Hospital in New Jersey.

Laboratory Parameters for Monitoring Target-Specific Oral Anticoagulants



* Hawes EM et al. J Thromb Haemost 2013; 11:1493-1502.

* Cuker A et al. J Am Coll Cardiol 2014; 64:1128-1139.

* Favaloro EJ et al. Semin Thromb Hemost 2015; 41:208-227.

* Samuelson BT et al. Blood Reviews 2017; 31:77-84.



Interim Analysis of Idarucizumab: REVERSE-AD



* Pollack CV et al. N Engl J Med 2015; 373:511-20.



Clinical Experiences Reported in Literature with Idarucizumab Following Approval by FDA



* Reviewed on Emergency Medicine PharmD



Fantastic Review on Idarucizumab



* Miller et al.



Use of Extracorporeal Measures to Expedite Elimination of Dabigatran in the Setting of Life-Threatening Bleeding



* Awad NI et al. J Med Toxicol 2015; 11:85-95.



Andexanet Alfa



* Siegal DM et al. N Engl J Med 2015; 373:2413-2424.

* Connolly SJ et al. N Engl J Med 2016; 375:1131-1141.



Low-Dose FEIBA for ICH Induced by Factor Xa Inhibitors

Mao G et al. JEM 2016 [Epub ahead of print].

Aripazine (PER977) AKA Ciraparantag



* Ansell JE et al. N Engl J Med 2014; 22:2141-2142.

* Ansell JE et al. Thromb Haemost 2017; 117:238-245.



Recommendations for Reversal of ICH Induced by Antithrombotics from Neurocritical Care Society



* Frontera JA et al. Neurocrit Care 2016; 24:6-46.



Excellent reviews on Idarucizumab



* Ann Emerg Med 2017;69(5):554

* EM Lit of Note



Dosing

Monoclonal antibody

works within minutes

Thrombin time and ECT are best monitoring, aPTT if stone-cold normal prob. rules out Dabi

Package comes with 2 vials

2.5 gm each

5 gms is the initial dose

Give each over 5 minutes

Spike and hang vial

give 2nd vial with 15 minutes of first (no reason not to give immediately)

$4200 for both vials at Janus General

Dabi lasts 12 hours in normal patients, and antidote lasts same ostensibly

Kcentra Studies



* RCT of Kcentra (Circulation 2013;128:1234)

Further episodes of EMCrit Podcast

Further podcasts by Scott D. Weingart, MD FCCM

Website of Scott D. Weingart, MD FCCM