Anticoagulants Reversal in Intensive Care Unit

Abstract

INTRODUCTION eversal of pharmacologic anticoagulation is an issue that arises when an anticoagulated patient has major bleeding or when a patient on chronic anticoagulant therapy requires urgent reversal of anticoagulation, for example, for surgery (Warkentin and Crowther, 2002). Blood coagulates as a result of the interaction between several circulating proteins in a cascading series of limited proteolytic reactions, culminating in thrombin formation. Several of these factors are targets for drug therapy (katzung et al., 2012). Platelets play a key role in the initiation of hemostatic mechanisms during vascular injury. The role of antiplatelet agents in prevention of atherosclerosis and coronary artery disease is well established, however, optimal duration of therapy and intensity of patient treatment are not settled and probably need to be individualized per patient (Acharji et al., 2013). Heparin, low molecular weight heparin and warfarin are well-established anticoagulants still in widespread use despite their well known drawbacks. Heparin requires continuous monitoring, has serious side-effects and lacks an oral route of administration. Low molecular weight heparin is a safer, more convenient anticoagulant to use but it cannot be given orally, does not have an antidote and may be difficult to administer in patients with renal R Introduction  90 failure. Warfarin has a narrow therapeutic window, interacts with other drugs and foods and requires monitoring like heparin (Benmira et al., 2010).