Clinics in laboratory medicine
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Review Comparative Study
Four-factor prothrombin complex concentrate versus plasma for urgent vitamin K antagonist reversal: new evidence.
Vitamin K antagonist (VKA) therapy is a mainstay of treatment for patients at risk of thromboembolic events. Despite widespread use, a major limitation of VKA therapy is the substantial risk of serious bleeding complications, which often require rapid reversal of anticoagulation. A recent randomized multicenter comparison between a 4-factor prothrombin complex concentrate (4F-PCC) and plasma in patients with acute major bleeding has provided important new evidence of the benefit of 4F-PCC over plasma for urgent VKA reversal.
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Review
Management of anticoagulation and hemostasis for pediatric extracorporeal membrane oxygenation.
Compared to in situ vascular physiology where pro and anti-hemostatic processes are in balance to maintain hemostasis, the use of ECMO in a critically ill child increases the risk of hemorrhagic or thromboembolic events due to a perturbation in the balance inherent of this complex system. The ECMO circuit has pro-hemostatic effects due to contact activation of hemostasis and inflammatory pathways. In addition, the critical illness of the child can cause dysregulation of hemostasis that may shift between hyper and hypocoagulable states over time.
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Every year, new studies are undertaken to address the complex issue of periprocedural management of patients on anticoagulants and antiplatelet medications. In addition, newer drugs add to the confusion among clinicians about how to best manage patients taking these agents. Using the most recent data, guidelines, and personal experience, this article discusses recommendations and presents simplified algorithms to assist clinicians in the periprocedural management of patients on anticoagulants.
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Bleeding is a significant complication of anticoagulant therapy. With the emergence of new oral anticoagulants (NOACs; ie, direct factor IIa or Xa inhibitors), this risk is further compounded by the lack of validated reversal strategies for these agents. ⋯ Several guidelines have recommended the use of hemostatic agents for NOAC reversal in patients with life-threatening bleeding. Ultimately, adequately powered studies will be crucial for full assessment of the effectiveness and safety of any proposed reversal strategies.
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Review
Perioperative management of patients receiving new oral anticoagulants: an international survey.
New oral anticoagulants (NOACs) are increasingly replacing standard anticoagulants. These new drugs have been recently introduced in clinical practice, and specific knowledge regarding preoperative interruption, anticoagulation assessment, and reversal therapies is needed. In this article, 3 main areas related to perioperative NOACs management are discussed: (1) physicians' knowledge, (2) current practices, and (3) perspectives to improve management of patients treated with NOACs.