Reversal and Reinitiation of Anticoagulation-References

References

Pdf Summary

The document compiles extensive references (1-111) concerning the reversal and reinitiation of anticoagulation therapy, with a focus period of 2024-2027. It addresses clinical impacts, management strategies, and outcomes related to bleeding complications in patients on oral anticoagulants used for conditions such as venous thromboembolism and atrial fibrillation.<br /><br />Key areas covered include:<br />- The clinical consequences of bleeding in anticoagulated patients (Refs 1, 39).<br />- Reversal agents and protocols for warfarin and direct oral anticoagulants (DOACs), including vitamin K, prothrombin complex concentrates (PCC), fresh frozen plasma, idarucizumab (for dabigatran), and andexanet alfa (for factor Xa inhibitors). Comparative efficacy and safety data for these agents are summarized (Refs 3, 4, 9-15, 18-20, 43-45).<br />- Guidelines and consensus pathways from major societies (American College of Cardiology, American Society of Hematology, European Heart Rhythm Association, American College of Gastroenterology, European Society of Gastrointestinal Endoscopy) on managing bleeding and perioperative anticoagulant handling (Refs 6-8, 12, 15-17, 33-38, 54-57).<br />- Management of gastrointestinal bleeding in anticoagulated patients, including endoscopic strategies, timing of procedures, and reinitiation of anticoagulation to balance bleeding risk against thrombosis (Refs 6, 8, 20-27, 33, 51, 69-71, 97-102).<br />- Intracerebral hemorrhage management focusing on reversal timing, outcomes, and the controversy of restarting anticoagulation (Refs 4, 39-42, 45, 84-96).<br />- Monitoring of anticoagulant activity and coagulation parameters to guide reversal and reinitiation (Refs 30-32, 72, 74).<br />- Alternative stroke prevention strategies when anticoagulation is contraindicated or complicated by bleeding, including left atrial appendage closure (Refs 106-111).<br />- Real-world evidence and systematic reviews supporting decisions on anticoagulant reversal and reinitiation after major bleeding events (Refs 5, 22, 23, 49, 50, 59, 60, 63).<br /><br />Overall, the literature emphasizes individualized risk-benefit assessment and multidisciplinary approaches to optimize patient outcomes in the setting of anticoagulant-associated bleeding, with evolving pharmacological and interventional options for reversal and stroke prevention.

Keywords

anticoagulation reversal

bleeding complications

oral anticoagulants

direct oral anticoagulants (DOACs)

warfarin reversal

gastrointestinal bleeding management

intracerebral hemorrhage

anticoagulant monitoring

stroke prevention strategies

left atrial appendage closure