Patients on anticoagulant therapy in emergencies

Abstract:

A need for urgent surgery or management of bleeding is rather common in patients on anticoagulant therapy. If possible, emergency surgery should be postponed until the normalization of coagulation. In the case of bleeding it is necessary to apply general measures to stop hemorrhage. In the case of life-threatening bleeding or urgent surgery, the anticoagulant effect should be first reversed. A reversal of anticoagulation is achieved by freshly frozen plasma in patients on warfarin; by specific reversion agent – idarucizumabom in patients on dabigatran; or by non-specific reverse agents – prothrombin complex or activated prothrombin complex in patients on other novel oral anticoagulants. Management of the patients on anticoagulant therapy in emergency situations using protocols for specific situations is usually successful and without many complications.

Key words:
anticoagulants; emergency surgery; hemorrhage; novel oral anticoagulants; warfarin