ICH – reverse anticoagulant

Posted On February 13, 2020

Received Vit K antagonist (Warfarin)

  • If INR is above normal
  • Use Vit K 10 mg iv, no faster than 1 mg/min, may repeat q 12 if inr remains high
  • 4-factor PCC (Protrhmobin complex concentrate): Kcentra, better than fresh frozen plasma 1500 to 2000 IU at 100 IU/min
  • If above not available, use Fresh frozen plasma
  • Check INR 30 min after PCC, and then every 6 hours for 24 hours, then daily to ensure INR in <1.4.
  • If INR remains elevated, repeat PCC

Received Dabigatran

  • idarucizumab (Praxbind) is recommended 2,5 g iv repeat in 15 min, total 5 g
    • if above not available, use activated PCC (Feiba) 50-80 mg units/kg
    • Oral activated charcoal if dabigatran taken withn 2 hours

Received Rivaroxaban or apixaban (fXa inhibitors)

  • 4-factor PCC: Kcentra (37.5–50 IU/kg)
    • 1500 to 2500 IU at 100 IU/min, or 50 units/kg
  • andexanet alfa may be considered
    • if patient on low dose of noac: 400 mg iv bolus at 30 mg/min, followed by iv 4 mg/min up to 120 min
    • if on high dose of noac: 800 mg iv bolus at 30 mg/min, followed by iv 8 mg/min up to 120 min

Received IV heparin

  • Protamine: 25 – 50 mg slow iv, less than 20 mg/min, may cause hypotension

Received Low molecular heparin

  • Enoxaparin in the previous 8 H reflexes: Protamine 1 mg per 1 mg of enoxaparin
  • Enoxaparin over 8 hours ago: Protamine 0.5 mg per 1 mg of enoxaparin

Reference

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