Anti-platelet agent reversal - Revision history

Elcatracho: /* See Also */

2021-03-06T03:01:15Z

ClaireLewis at 16:18, 25 October 2019

2019-10-25T16:18:12Z

← Revisión anterior		Revisión del 16:18 25 oct 2019
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	**[[Clopidogrel]]		**[[Clopidogrel]]
	**[[Ticagrelor]]		**[[Ticagrelor]]
	**Ticlopidine (rarely used anymore)		**[[Ticlopidine]] (rarely used anymore)
	*Prevalence of immediate traumatic ICH in pts on clopidogrel 12% compared to 5% on warfarin<ref>Nishijima DK et al. Immediate and delayed traumatic intracranial hemorrhage in patients with head trauma and preinjury warfarin or clopidogrel use. Ann Emerg Med. 2012 Jun;59(6):460-8.e1-7.</ref>		*Prevalence of immediate traumatic ICH in pts on clopidogrel 12% compared to 5% on [[warfarin]]<ref>Nishijima DK et al. Immediate and delayed traumatic intracranial hemorrhage in patients with head trauma and preinjury warfarin or clopidogrel use. Ann Emerg Med. 2012 Jun;59(6):460-8.e1-7.</ref>
	**May be confounded by ~~pts~~ on warfarin having low threshold for presenting with head injury to ED, but highlights high frequency of bleeds in ~~pts~~ on clopidogrel		**May be confounded by patients on warfarin having low threshold for presenting with head injury to ED, but highlights high frequency of bleeds in patients on clopidogrel
	**However, no ~~pts~~ on clopidogrel had delayed ICH compared to ~1% pts on warfarin with delayed ICH		**However, no patients on clopidogrel had delayed ICH compared to ~1% pts on warfarin with delayed ICH
	**Delayed ICH defined as traumatic ICH within 2 weeks after initial normal CTH		**Delayed ICH defined as traumatic ICH within 2 weeks after initial normal CTH
	*Platelet aggregation recovery<ref>Li C et al. Reversal of the anti-platelet effects of aspirin and clopidogrel. J Thromb Haemost. 2012 Apr;10(4):521-8.</ref>:		*Platelet aggregation recovery<ref>Li C et al. Reversal of the anti-platelet effects of aspirin and clopidogrel. J Thromb Haemost. 2012 Apr;10(4):521-8.</ref>:
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	*Limited evidence to support mortality improvement in reversal, but little evidence of harm<ref>Orlando Regional Medical Center. Department of Surgical Education. ANTIPLATLET AGENT REVERSAL IN ADULTS WITH TRAUMATIC INTRACRANIAL HEMORRHAGE. http://www.surgicalcriticalcare.net/Guidelines/TBI%20Antiplt%20Reversal%20Guideline%202012.pdf.</ref>		*Limited evidence to support mortality improvement in reversal, but little evidence of harm<ref>Orlando Regional Medical Center. Department of Surgical Education. ANTIPLATLET AGENT REVERSAL IN ADULTS WITH TRAUMATIC INTRACRANIAL HEMORRHAGE. http://www.surgicalcriticalcare.net/Guidelines/TBI%20Antiplt%20Reversal%20Guideline%202012.pdf.</ref>

	===Platelet transfusion===		===[[Platelet transfusion]]===
	*Volume		*Volume
	**At least 5 units of platelets initially to reverse routine antiplatelet doses<ref>Powner DJ, Hartwell EA, Hoots WK, et.al. Counteracting the effects of anticoagulants oand		**At least 5 units of platelets initially to reverse routine antiplatelet doses<ref>Powner DJ, Hartwell EA, Hoots WK, et.al. Counteracting the effects of anticoagulants oand
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	==Special Circumstances==		==Special Circumstances==
	*Chronic renal failure patients may benefit from:		*Chronic renal failure patients may benefit from:
	**Desmopressin		**[[DDAVP\|Desmopressin]]
	**OR [[cryoprecipitate]] 1 unit		**OR [[cryoprecipitate]] 1 unit
	**Conjugated estrogens IV 0.6mg/kg/d for 5 days<ref>Livio M, Mannucci PM, Viganò G, et.al. Conjugated estrogens for the management of bleeding		**Conjugated estrogens IV 0.6mg/kg/d for 5 days<ref>Livio M, Mannucci PM, Viganò G, et.al. Conjugated estrogens for the management of bleeding

ClaireLewis: /* Special Circumstances */

2019-09-30T23:33:06Z

Special Circumstances

← Revisión anterior		Revisión del 23:33 30 sep 2019
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	*Chronic renal failure patients may benefit from:		*Chronic renal failure patients may benefit from:
	**Desmopressin		**Desmopressin
	**OR cryoprecipitate 1 unit		**OR [[cryoprecipitate]] 1 unit
	**Conjugated estrogens IV 0.6mg/kg/d for 5 days<ref>Livio M, Mannucci PM, Viganò G, et.al. Conjugated estrogens for the management of bleeding		**Conjugated estrogens IV 0.6mg/kg/d for 5 days<ref>Livio M, Mannucci PM, Viganò G, et.al. Conjugated estrogens for the management of bleeding
	associated with renal failure. N Engl J Med. 1986; 315:731-5.</ref>		associated with renal failure. N Engl J Med. 1986; 315:731-5.</ref>

Rossdonaldson1: Text replacement - " wks " to " weeks "

2019-03-30T15:40:37Z

Text replacement - " wks " to " weeks "

← Revisión anterior		Revisión del 15:40 30 mar 2019
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	**May be confounded by pts on warfarin having low threshold for presenting with head injury to ED, but highlights high frequency of bleeds in pts on clopidogrel		**May be confounded by pts on warfarin having low threshold for presenting with head injury to ED, but highlights high frequency of bleeds in pts on clopidogrel
	**However, no pts on clopidogrel had delayed ICH compared to ~1% pts on warfarin with delayed ICH		**However, no pts on clopidogrel had delayed ICH compared to ~1% pts on warfarin with delayed ICH
	**Delayed ICH defined as traumatic ICH within 2 ~~wks~~ after initial normal CTH		**Delayed ICH defined as traumatic ICH within 2 weeks after initial normal CTH
	*Platelet aggregation recovery<ref>Li C et al. Reversal of the anti-platelet effects of aspirin and clopidogrel. J Thromb Haemost. 2012 Apr;10(4):521-8.</ref>:		*Platelet aggregation recovery<ref>Li C et al. Reversal of the anti-platelet effects of aspirin and clopidogrel. J Thromb Haemost. 2012 Apr;10(4):521-8.</ref>:
	**Within 4 days of stopping aspirin		**Within 4 days of stopping aspirin

Kxl328 at 03:15, 9 November 2018

2018-11-09T03:15:23Z

← Revisión anterior		Revisión del 03:15 9 nov 2018
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	===Desmopressin ([[DDAVP]])<ref>Hedges SJ, Dehoney SB, Hooper JS, et.al. Evidence-based treatment recommendations for uremic		===Desmopressin ([[DDAVP]])<ref>Hedges SJ, Dehoney SB, Hooper JS, et.al. Evidence-based treatment recommendations for uremic
	bleeding. Nature Clin Prac. 2007;3(3):138-53.</ref>===		bleeding. Nature Clin Prac. 2007;3(3):138-53.</ref>===
	**0.3 mcg/kg/dose in 50 cc NS over 30 min<ref>. Gratz I, Koehler J, Olsen D, et.al. The effect of desmopressin acetate on postoperative hemorrhage in		*0.3 mcg/kg/dose in 50 cc NS over 30 min<ref>. Gratz I, Koehler J, Olsen D, et.al. The effect of desmopressin acetate on postoperative hemorrhage in
	patients receiving aspirin therapy before coronary artery bypass operations. J Thorac Cardiovasc		patients receiving aspirin therapy before coronary artery bypass operations. J Thorac Cardiovasc
	Surg. 1992; 104:1417-22.</ref>		Surg. 1992; 104:1417-22.</ref>

Rossdonaldson1: /* Background */

2018-10-22T02:54:55Z

Background

← Revisión anterior		Revisión del 02:54 22 oct 2018
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	**Aspirin alone is predictor of higher mortality in spontaneous ICH<ref>Saloheimo P, Ahonen M, Juvela S, et.al. Regular aspirin-use preceeding the onset of primary		**Aspirin alone is predictor of higher mortality in spontaneous ICH<ref>Saloheimo P, Ahonen M, Juvela S, et.al. Regular aspirin-use preceeding the onset of primary
	intracerebral hermoorhage is an independent predictor for death. Stroke. 2006;37:129-33.</ref>		intracerebral hermoorhage is an independent predictor for death. Stroke. 2006;37:129-33.</ref>
	*PATCH trial in 2016 '''suggested mortality is higher in platelet transfused patients''', alongside several other preceding studies<ref>Baharoglu MI et al. Platelet Transfusion Versus Standard Care After Acute Stroke due to Spontaneous Cerebral Haemorrhage Associated with Antiplatelt Therapy (PATCH): A Randomised, Open-Label, Phase 3 Trial. Lancet 2016; 1 – 9.</ref>		*[[PATCH trial]] in 2016 '''suggested mortality is higher in platelet transfused patients''', alongside several other preceding studies<ref>Baharoglu MI et al. Platelet Transfusion Versus Standard Care After Acute Stroke due to Spontaneous Cerebral Haemorrhage Associated with Antiplatelt Therapy (PATCH): A Randomised, Open-Label, Phase 3 Trial. Lancet 2016; 1 – 9.</ref>
	**2.05 OR, increased odds of death at 3 months in platelet transfusion group		**2.05 OR, increased odds of death at 3 months in platelet transfusion group
	**190 ICH patients enrolled		**190 ICH patients enrolled

Rossdonaldson1: /* Reversal */

2018-10-22T02:54:25Z

Reversal

← Revisión anterior		Revisión del 02:54 22 oct 2018
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	*Reversal with combination of platelet transfusion, [[desmopressin]]		*Reversal with combination of platelet transfusion, [[desmopressin]]
	*Limited evidence to support mortality improvement in reversal, but little evidence of harm<ref>Orlando Regional Medical Center. Department of Surgical Education. ANTIPLATLET AGENT REVERSAL IN ADULTS WITH TRAUMATIC INTRACRANIAL HEMORRHAGE. http://www.surgicalcriticalcare.net/Guidelines/TBI%20Antiplt%20Reversal%20Guideline%202012.pdf.</ref>		*Limited evidence to support mortality improvement in reversal, but little evidence of harm<ref>Orlando Regional Medical Center. Department of Surgical Education. ANTIPLATLET AGENT REVERSAL IN ADULTS WITH TRAUMATIC INTRACRANIAL HEMORRHAGE. http://www.surgicalcriticalcare.net/Guidelines/TBI%20Antiplt%20Reversal%20Guideline%202012.pdf.</ref>
	*Platelet transfusion ~~volume:~~
			===Platelet transfusion===
			*Volume
	**At least 5 units of platelets initially to reverse routine antiplatelet doses<ref>Powner DJ, Hartwell EA, Hoots WK, et.al. Counteracting the effects of anticoagulants oand		**At least 5 units of platelets initially to reverse routine antiplatelet doses<ref>Powner DJ, Hartwell EA, Hoots WK, et.al. Counteracting the effects of anticoagulants oand
	antiplatelet agents during neurosurgical emergencies. Neurosurgery. 2005; 57:823-31.</ref>		antiplatelet agents during neurosurgical emergencies. Neurosurgery. 2005; 57:823-31.</ref>
	**Consider significantly more platelets for those who were loaded with clopidogrel within the last week<ref>Downey DM, Monsn B, Butler KL, et.al. Does platelet administration affect mortality in elderly headinjured		**Consider significantly more platelets for those who were loaded with clopidogrel within the last week<ref>Downey DM, Monsn B, Butler KL, et.al. Does platelet administration affect mortality in elderly headinjured
	patients taking antiplatelet medications? Am Surg. 2009;75(11):1100-3.</ref>		patients taking antiplatelet medications? Am Surg. 2009;75(11):1100-3.</ref>
	*Desmopressin ([[DDAVP]])<ref>Hedges SJ, Dehoney SB, Hooper JS, et.al. Evidence-based treatment recommendations for uremic
	bleeding. Nature Clin Prac. 2007;3(3):138-53.</ref>		===Desmopressin ([[DDAVP]])<ref>Hedges SJ, Dehoney SB, Hooper JS, et.al. Evidence-based treatment recommendations for uremic
			bleeding. Nature Clin Prac. 2007;3(3):138-53.</ref>===
	**0.3 mcg/kg/dose in 50 cc NS over 30 min<ref>. Gratz I, Koehler J, Olsen D, et.al. The effect of desmopressin acetate on postoperative hemorrhage in		**0.3 mcg/kg/dose in 50 cc NS over 30 min<ref>. Gratz I, Koehler J, Olsen D, et.al. The effect of desmopressin acetate on postoperative hemorrhage in
	patients receiving aspirin therapy before coronary artery bypass operations. J Thorac Cardiovasc		patients receiving aspirin therapy before coronary artery bypass operations. J Thorac Cardiovasc

Jonwarren: Updated links

2018-08-17T13:22:49Z

Updated links

← Revisión anterior		Revisión del 13:22 17 ago 2018
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	**2.05 OR, increased odds of death at 3 months in platelet transfusion group		**2.05 OR, increased odds of death at 3 months in platelet transfusion group
	**190 ICH patients enrolled		**190 ICH patients enrolled
	***Included patients with at least 7 days of antiplatelet therapy, including ASA, clopidogrel, dipyridamole		***Included patients with at least 7 days of antiplatelet therapy, including [[ASA]], [[clopidogrel]], [[dipyridamole]]
	***Excluded SDH, epidural hemorrhage, aneurysm, AVM, surgical evacuation of ICH within 24 hrs, thrombocytopenia < 100k, use of warfarin if INR > 2-3, infratentorial hematomas, large intraventricular hemorrhage		***Excluded SDH, epidural hemorrhage, aneurysm, AVM, surgical evacuation of ICH within 24 hrs, thrombocytopenia < 100k, use of warfarin if INR > 2-3, infratentorial hematomas, large intraventricular hemorrhage
	*Anti-platelet medications to reverse:		*Anti-platelet medications to reverse:

Kxl328 at 15:37, 8 February 2017

2017-02-08T15:37:01Z

← Revisión anterior		Revisión del 15:37 8 feb 2017
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	==Background==		==Background==
	*~~Reversal~~ of [[aspirin]] and [[clopidogrel]] in acute life threatening hemorrhage, but is controversial in [[ICH]]<ref>Ohm C, Mina A, Howells G, et.al. Effects of antiplatelet agents on outcomes for elderly patients with		*Consider reversal of [[aspirin]] and [[clopidogrel]] in acute life threatening hemorrhage, but it is very controversial in [[ICH]]<ref>Ohm C, Mina A, Howells G, et.al. Effects of antiplatelet agents on outcomes for elderly patients with
	traumatic intracranial hemorrhage. J Trauma. 2005;58:518-22.</ref>		traumatic intracranial hemorrhage. J Trauma. 2005;58:518-22.</ref>
	**Risk of mortality from ICH on [[warfarin]] ~16-80%		**Risk of mortality from ICH on [[warfarin]] ~16-80%

Kxl328 at 15:36, 8 February 2017

2017-02-08T15:36:00Z

← Revisión anterior		Revisión del 15:36 8 feb 2017
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	intracerebral hermoorhage is an independent predictor for death. Stroke. 2006;37:129-33.</ref>		intracerebral hermoorhage is an independent predictor for death. Stroke. 2006;37:129-33.</ref>
	*PATCH trial in 2016 '''suggested mortality is higher in platelet transfused patients''', alongside several other preceding studies<ref>Baharoglu MI et al. Platelet Transfusion Versus Standard Care After Acute Stroke due to Spontaneous Cerebral Haemorrhage Associated with Antiplatelt Therapy (PATCH): A Randomised, Open-Label, Phase 3 Trial. Lancet 2016; 1 – 9.</ref>		*PATCH trial in 2016 '''suggested mortality is higher in platelet transfused patients''', alongside several other preceding studies<ref>Baharoglu MI et al. Platelet Transfusion Versus Standard Care After Acute Stroke due to Spontaneous Cerebral Haemorrhage Associated with Antiplatelt Therapy (PATCH): A Randomised, Open-Label, Phase 3 Trial. Lancet 2016; 1 – 9.</ref>
	**2.05 OR increased odds of death at 3 months in platelet transfusion group		**2.05 OR, increased odds of death at 3 months in platelet transfusion group
	**190 ICH patients enrolled		**190 ICH patients enrolled
	***Included patients with at least 7 days of antiplatelet therapy, including ASA, clopidogrel, dipyridamole		***Included patients with at least 7 days of antiplatelet therapy, including ASA, clopidogrel, dipyridamole

← Revisión anterior		Revisión del 03:01 6 mar 2021
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	*[[Coagulopathy (main)]]		*[[Coagulopathy (main)]]
	*[[Anticoagulant reversal for life-threatening bleeds]]		*[[Anticoagulant reversal for life-threatening bleeds]]
			*[[Antiplatelet medications]]

	==References==		==References==